LETTERS.

Physician, Train Thyself

The article "Better Training: in Misoprostol Use for Labor Induction Advocated" seemed heavily slanted against the use of misoprostol and failed to address the true issues (May 15, 2001, p. 13).

The obstetricians of Washington state may be surprised that 22% of their colleagues do not think that previous cesarean section is a contraindication to the use of misoprostol for induction of labor. Every provider, should be aware of the risks of any medication he or she prescribes, especially for an off-label use. In such cases, published studies provide safety and efficacy data.

The fact that only 8% of providers had used misoprostol during their training is not relevant, since its use for labor induction has become popular in only the last few years. There was no mention of institutional protocols for the use of misoprostol. A survey of current teaching in residency programs and of the presence of hospital protocols would better reflect the appropriateness of the use of misoprostol.

My partner and I went to great lengths to develop a protocol that was accepted by our medical executive committee. Our efforts were initially resisted by those primarily concerned about medicolegal risks. However, we presented the abundant data in the literature as well as the supporting statements by the American College of Obstetricians and Gynecologists.

The use of misoprostol for labor induction requires that practitioners be educated on the risks and benefits. Who should bear the responsibility of education? Each practitioner must be responsible for staying current in his or her specialty and become very knowledgeable ...