Induction scheduled...

[MomtoXane]

Unless something else comes up my OB plans to induce me at 40wks. She told me that pitocin is OK for VBAC, but cervidil is not. So I'm hoping for a favorable cervix! I went into labor naturally with my last VBAC, so I'm nervous about induction. Advice is welcome! I'm happy that a repeat c/s is her last last resort.

[thorn]

why is she inducing you at 40 weeks?!

[alegna]

Why are you agreeing to be induced at 40 weeks?

-Angela

[Drummer's Wife]

I, personally, would not be comfortable with pitocin and a vbac. Did you have it before? It's pretty awful, stong, forceful (but not necessarily productive) contractions. It seems like it would be more likely to lead to more interventions and another section.

I'd hold off on the induction unless it's medically necessary.

[chely7425]

I too would not be comfortable being induced and trying for a VBAC unless there are other medical reasons for induction. Pitocin is awful stuff...

[Taryn237]

40 weeks is really early. What if your EDD is off? My midwives don't induce until 42 weeks... and I fudged my dates a bit so it would really be 42w3d. I better not go that long!

And if I do I might refuse. Obviously I haven't told them that yet (or even DH) but I can't even imagine being induced again (c/s for failed induction with DS).

If there is absolutely no way you can switch OBs or refuse a 40 week induction I would try to get labor started by natural means first. I'm taking EPO twice a day orally and at bedtime internally. I've also starting pumping (for IGT not induction) but it definitly gets contractions coming for a bit.

[ancoda]

I would refuse. I would not tell them I am refusing till near the last minute, they can not abandon you. My 2 VBACs were at 42w4days and 42w2days, and they were just fine.
If there is no reason to induce you, beyond the fact that that is what your OB wants, say too bad.
I have heard that pitocin is safer then cervidil, but that is not saying much. It is still highly unsafe to try to VBAC with.

[thorn]

Originally Posted by ancoda

I have heard that pitocin is safer then cervidil, but that is not saying much. It is still highly unsafe to try to VBAC with.

It actually is a pretty significant difference. 1.2% rupture rate with pitocin vs. 2.9% with cervadil - http://www.homebirth.org.uk/vbacinduction.htm

[OceansEve]

I would postpone. If you don't feel comfortable just saying no (which is your right, they cannot force it on you and they CANNOT dump you from service at this point), come up with an excuse to "reschedule" and then oops "reschedule" again. I wouldn't even consider induction until past 42 weeks and it would be a very LONG discussion. Even if you are at 40 weeks, babe will tell you when they are ready to come out. I would be so angry if I was convinced to induce by an OB and ended up with another c/s because my body just wasn't ready to birth.

[odenata]

I agree with others, that there is no reason to agree to an induction at 40 weeks, and even if I did decide to induce, before pitocin, I would try other induction methods first, like stripping membranes and cervical massage, or a foley or cook catheter. Also, if pitocin is used for VBAC, it should be very low dose.

[FernG]

Originally Posted by thorn

It actually is a pretty significant difference. 1.2% rupture rate with pitocin vs. 2.9% with cervadil - http://www.homebirth.org.uk/vbacinduction.htm

And isn't it a 0.5% chance without induction? That means pitocin more than doubles the risk of rupture.

[thorn]

Originally Posted by FernG

And isn't it a 0.5% chance without induction? That means pitocin more than doubles the risk of rupture.

yes. although we don't know how the inductions in the study were carried out either - did the start the pit off low and slow? or crank it up like a baby story induction? did they stop it once contractions became regular, etc...

still, better to avoid if possible, though I would choose a gentle pit induction over going straight to the c/s...

[kltroy]

Inducing right at 40 weeks seems a bit heavy handed if it's just because "you're due". Is there a medical reason? I'd wait, get an NST at 41 weeks if you're still pregnant, and go from there. Try a membrane sweep, sex, even castor oil. Ultimately, do what you're comfortable with. I remember having "the induction" talk with my FP doc this past summer... it went something like this:

Her: so how long do you want to go with this before we do anything?
me: 42 weeks as long as my baby looks good. Hopefully she makes an appearance before then!
her: most people will want to induce at 41 weeks. That's the standard these days.
me: yes, but I really want to avoid that unless there's a good reason
her: ok we'll wait it out unless your baby needs to get evicted. Shall we try a membrane sweep?

Not sure how YOUR talk went, but you can always revisit the issue - right up to, and beyond, the day your induction is scheduled. Good luck!

[maotmsmi]

Not to state what has already been said but I would question how supportive your DR is if 40 weeks is the cutoff you are given. Do you have a medical reason for induction because it seems kind of early for your DR to be setting an induction date. IMO...

My DR didn't offer induction until 41 weeks and I was able to hold him off until 42 weeks 1 day. I still regret letting them scare me with the "dead baby" card because my induction ended in a repeat c/s. There will be soooo much intervention to fight if you get to the hospital before you are in labor, even the *friendly* hospitals. That being said, I was induced with a foley bulb, got to 4cm (from 2cm) in about 5 min. and then was put on a slow pit. drip that was upped over 26 hours or so and my scarred uterus and baby handled it just fine! *For me* I would definitely try some sort of induction before going to a repeat c/s. However, I would, and did try all natural methods first (including castor oil). Baby just simply wasn't ready and I will have to be much more patient next time. LOL

[MomtoXane]

Yes I have medical reason to be induced, I cannot go over due. I've been having 2x weekly NSTs since 32wks, biophysical profiles/AFI, growth scans, etc. This is the first OB who is even letting me attempt a natural birth. She said she would start sweeping membranes weekly and break my water if I'm able to dialate to 3cm on my own. I understand how induction at 40wks is arbitrary in MOST cases, but not here...

[thepeach80]

I was induced w/ Ilana at 39 wks. I was 4cm and 0 station. Pit was started at 10:30, they broke my water at 12:30 and she was here at 2:04. 3.5 hrs from start to finish! This was my 2nd VBAC as well so I knew my scar and pelvis were 'proven' etc. Unless baby is here by then, we'll probably induce again at 39 wks. Good luck!

[HappyMommaBear]

I have had pitocin, and would refuse to use it again, especially having had a c-section. A lot of doctors use pit induction for a VBAC, and many of their patients end up with a repeat cesarean. I would keep pushing, and if I was going to induce or do a repeat cesarean, it would be as a last resort and certainly not at 40 weeks.
Something we seem to have forgotten in today's schedule-oriented society, is that 40 weeks is just an average. It used to be that anything from 38-42 weeks was considered full term, but these days OBs give us a very small window with which they are comfortable.
My oven cooks at 400 degrees, as does yours I'm sure. But, it may take an hour to cook something at 400 in my oven, that would only take 45 minutes in yours. Recipes even account for the fact that times may vary depending on the oven. Why can we understand that and go on without question, but insist that something so much more complex, like the human body, has to be ready to deliver in exactly 40 weeks?!

[meatloafkend]

When I had my VBAC I was given an induction date. That date hung over my head and I believe kind of stressed me. I thought, "I'd better go into labor before...". I ended up trying castor oil 2 days before the scheduled induction, and whether that was that was the reason or not, I went into labor.

40 weeks is definitely early! Both of my babies were late. My second (VBAC) was 12 days overdue. She wasn't too big either. My EDD was probably just slightly off.

[thorn]

Originally Posted by MomtoXane

Yes I have medical reason to be induced, I cannot go over due. I've been having 2x weekly NSTs since 32wks, biophysical profiles/AFI, growth scans, etc. This is the first OB who is even letting me attempt a natural birth. She said she would start sweeping membranes weekly and break my water if I'm able to dialate to 3cm on my own. I understand how induction at 40wks is arbitrary in MOST cases, but not here...

If you are having these tests done though, then isn't 40 weeks still an arbitrary date? shouldn't you go as long as necessary as long as the baby is ok?

[MissE]

Originally Posted by meatloafkend

I ended up trying castor oil 2 days before the scheduled induction, and whether that was that was the reason or not, I went into labor.

Argh. I did castor oil twice...nada...had my membranes stripped 3 times...nada. I got induced with a little bit of pit (I was 6cm dilated, 80%effaced for days), my waters were broken and 45 minutes later, DD was born.