Induction after previous cesarean?

[chrysanthemums]

Okay, here's a hypothetical question . What's the safest way to induce labor when you're trying for a VBAC? (I know, ideally labor will start naturally and induction is to be avoided at all costs ) Is it safer to have a repeat cesarean than to induce with pitocin? I'm trying to find information about this online but so far have come up short.

[mamatoakd]

I'm not sure what the absolute answer is, but it probably depends on a number of variables including the size of your baby, your doctor, etc. When I was pregnant with #2, I tried for a VBAC. I discussed induction with my dr at around 41 weeks but was told that it wouldn't be an option given that this was to be a VBAC and the baby was on the larger end (over 8 lbs).

Good luck!

[Snow Cherries]

I'm far from an expert, but thought I'd share my situation with you. I'm hoping for a vbac, but due to the really messed up fact that I'm losing insurance coverage 5 days before my edd (you can check out my post in the vbac forum), I'm faced with either trying to induce a vbac or just schedule a repeat c-section.

What my midwife has told me (and what we are planning to try in 36 hours) is that the safest way to attempt a vbac induction is by placing a foley catheter in the cervix and filling the balloon on the end with saline which ideally should irritate the cervix into dilating and starting a contraction pattern. If this works (which would mean the balloon helps you dilate to about 3-4 cm and starts good contractions), she has told me that it should be safe to use a very little bit of pitocin to encourage a steady labor pattern (assuming low transverse incision from previous c-section, no complications etc.). I must admit that I'm not totally sure that I will consent to the pitocin, but the foley catheter method itself seems safe from the research I've done. If this method does not work, then I believe a rcs would be recommended. I have heard from a few mamas on this site that the foley catheter itself, even without pitocin helped their labor start and they had successful vbacs using this method which is very encouraging!

Of course, like you said, allowing your body to go into labor naturally would be the best option (an option I wish I had) for a safe, successful vbac.

I did a search for foley catheter induction on google and found a site that outlined what I think was the World Health Organization's guidelines for safe induction (both regular vaginal delivery and vbac) and it was very, very similar to what my midwife described to me. I really don't know if the WHO is considered a good source of info, but it was still somewhat reassuring to me.

I did find it difficult to find a lot of info about vbac induction, so you may have to dig quite a bit. Good luck!

[wombatclay]

If you scroll down to the bottom of this page, you'll find a chart comparing the different induction techniques in VBAC mamas in regards to the risk of uterine rupture (which is the "boogey man" of vbac induction so to speak).

In case you don't want to wade through the whole paper, the summary of conclusion is

---The rate of uterine rupture with induced trial of labour (TOL) is significantly higher than with spontaneous trial of labour.
---PGE2 exposure during TOL is associated with more than a 6-fold increase in uterine rupture when compared to spontaneous TOL.
---Foley catheter induction is associated with the lowest rupture rate in the induced TOL group and is comparable to spontaneous TOL.

In terms of comparing the risks of induction with rc/s you get into something closer to comparing apples and oranges. You'll have to decide which risks are more significant for you, which are more significant for your child, etc. And keep in mind that several of the risks of rc/s are "downstream"... so some risks may matter more to you if you are planning more children (fertility issues, miscarriage, placental problems, etc that are linked to prior c/s and increase with each repeat) and less if you're planning to stop with this child. The ICAN website has articles on both VBAC risk and RC/S risk so that is one place to start.

Happy birthing! Hope you don't need the info!

[thepeach80]

I was 4cm and 0 station when I went in so very little was needed. We started the pit and I asked that we just use pit and not break my water. My DR said he felt he would rather speed things along w/ breaking my water vbs using a lot of pit (this is true from my past histories, it may not apply for everyone). I thought that sounded logical so I agreed. I was on pit for 2 hrs before they broke my water and then Ilana was born 1.5 hrs later.