Conflicted, Need Advice...

[chely7425]

Ok, so this might come out a tad jumbled but here is the current situation. I had my son via c-section almost exactly 14 months ago. My EDD was yesterday and we are hoping for a VBAC. I had a c-section because DS literally would not fit out... kid had a 16 inch head and I have a small pelvis which is oddly shaped from some previous injuries. If he hadn't had such a gigantor head though I think it would have worked fine. Now, my OB is very supportive of a VBAC but we are getting to a point where we need to start thinking about what happens if I don't go into labor on my own. She said she would be willing to try and induce but I am really not ok with that. DS was an induction and neither of us reacted well to the pitocin and it was very scary. So I think an induction is kind of out, plus it ups the risk of uterine rupture to a point that I really don't think I am ok with. So that leaves us with scheduling a c section... what would you do?

[Ianthe]

Can you try other natural induction methods before a medical induction or c/s? I took castor oil with DS1 at 41 weeks when I was worried about getting a pit induction, and I would do it again in a heartbeat if it meant I was facing what you are facing.

I'm not saying you SHOULD do castor oil.. but is that something you can consider?

[chely7425]

We are definitely trying other natural things... trying to have lots of sex (though its getting very awkward!!!) and my doc stripped my membranes again today... I just really don't know what the best thing to do here is, ya know? I think both me and DH would be more comfortable going straight to a repeat c/s as opposed to trying a pit induction again... I just wish I knew what to do for sure!! Maybe I will just go into labor in the next few days and this won't be an issue?

[chely7425]

So I found this on the ICAN website regarding pitocin and VBACs:

Uterine Rupture



Finally, there is the issue of uterine rupture. The facts are clear: pharmaceutical induction increases the risk of uterine rupture.39 The rate of rupture in a VBAC labor which is not induced is only 1/2 of one percent, less than your risk of experiencing several other major childbirth complications. However, when you add induction to the picture, the risks increase. A recent study which gained a great deal of media attention showed that in VBAC labors induced with Pitocin, the risk of rupture was .77%. With prostaglandin inductions, the rupture rate increased to 2.45%!40



Almost every study verifies the risk of induction in VBACs, although some report no increase in rupture rate with induction.41 In a study which included 752 women, 12 uterine ruptures occurred, 11 of which were associated with the use of induction or augmentation or both. The authors stated that VBAC is safe, but VBAC with induction is not.42 In a study quoted above on the efficacy of induction, uterine scar separation was found to be 7% in the induced labors.43



A review of almost 115,000 births in Canada confirmed that induction and augmentation of labor (using chemical agents to stimulate greater uterine activity in a labor which began on its own) are definite risk factors for uterine rupture.44 Although augmentation of labor may be less questionable an option than induction because labor has already begun, the risk of rupture remains. A study from Israel concluded that using oxytocin and prostaglandin added to the risk of rupture.45 Another study confirmed that spontaneous labors had a low (0.45%) risk of rupture, but that using prostaglandin gel increased the risk by 6.41 times.46


I am not overly sure what some of that means though... can anyone help?

[jessielove]

Have you considered seeing an acupuncturist? This has been suggested strongly to me by my midwife. Acupuncture with an acu. experienced with pregnancy can help to soften and ripen your cervix and put your body into the prime favorable position for labor.

[chely7425]

I know accupuncture can be really good but the closest accupuncturist is 2 hours away and there is no way we can afford it... sucks living in the middle of nowhere.

[amandaleigh37]

but we are getting to a point where we need to start thinking about what happens if I don't go into labor on my own.

What makes her think you won't go into labor on your own? How far along are you?

[chely7425]

I am 40.5 weeks and we are just at the point where we need to start thinking about what we are going to do if he doesn't come on his own. Weighing the options and such. She isn't forcing me into anything she just wants us to start thinking about it, which I would much prefer to a rushed decision.

[stanleymama]

Since you are trying natural ways of inducing yourself and its not working so far, I would think about the c-sec. I would give yourself a deadline, and if baby doesn't come by then, or you are not dilated enough to where your water could be broken to help start labor, then schedule the c-sec. I would not do the pit induction since the risks are against you and you already know that you don't react well to the pit. Just my humble opinion and what I would do.

[chely7425]

Originally Posted by stanleymama

Since you are trying natural ways of inducing yourself and its not working so far, I would think about the c-sec. I would give yourself a deadline, and if baby doesn't come by then, or you are not dilated enough to where your water could be broken to help start labor, then schedule the c-sec. I would not do the pit induction since the risks are against you and you already know that you don't react well to the pit. Just my humble opinion and what I would do.

This is kind of what I am leaning towards... Our OB is also very supportive of making a c/s if we need it a positive experience. She is totally open to dropping the curtain thing so I can see the baby being born and nursing right away and everything... I just want this baby to cooperate!!

[RachaelsMommy]

How about a chiropractor? They can make sure everything is lined up correctly in your pelvis to allow the baby more room to get in the right position. How long is the doctor willing to give you? I'm pretty sure 95% of babies arrive before 42 weeks.

If all else fails, would your doctor be willing to induce by Foley catheter or by breaking your water? I know breaking water isn't always recommended b/c most OBs will expect you to deliver within 24 hours. But if the only other option is scheduled c/s then it could be a good choice.

Oh another thing I don't think was mentioned was nipple stimulation.

[sunflwrmoonbeam]

It sounds like spending a week or so trying the natural methods and if that doesn't work going in for a c/s is the best option for you. At least, that's what I'd do.

[chely7425]

Chiropractic (like accupuncture) isn't an option because of distance and cost... I really wish it was though. I think our current plan is to give it a week of trying natural methods and if no baby by then we will keep our scheduled section on the 18th. If we have to have a c-section that is fine but I want to be able to plan it and make it a good experience. My frist one actually was a very positive experience for an emergency c/s because my midwife and the hospital staff were amazing so if we have to have a birth that isn't ideal I still want it to be mine if that makes sense... I am so glad to have you ladies to bounce things off of though!!

[blessedwithboys]

crashing your ddc to offer my 2 cents...

if your baby wont fit through your pelvis at 42wks, your baby wont fit at 40.5 wks...baby doesnt grow THAT MUCH at this point. if are are at real risk of CPD, your baby is probably already "too big". i totally understand the need to have a csec go your way, i've had two myself. in your case i would consider doing nothing and having a trial of (natural) labor.

def would NOT induce, naturally or artifically, cuz really, theyre all artifical methods. have your backup csec birth plan, but just let your body go on its own. that way, if your truly experience CPD after natural onset of labor, your baby will not have been subjected tot he stress of an artifical eviction and will be better able to handle surgical birth.

[channelofpeace]

I understand your hesitation with going to a pit induction on a vbac. I have been in the same situation. My first was a c-section for breech. I was hoping to vbac with my second, but I had very low amniotic fluid at term. So instead of a pit induction, I had a second c-section. With my third, he needed to come out at 37 weeks due to blood incompatibility, but I didn't want to skip straight to a c-section if possible, so I started to look at other options. I had a foley catheter induction. They placed the catheter in the morning, I took a nap and then I started doing manual nipple stimulation in the afternoon. I never needed any pit at all, since the nipple stimulation was releasing my own oxytocin. At some point, I decided to try a breast pump, and that ramped things up. I ended up with a vba2c with no chemical induction or augmenting : It was a pretty long ordeal, but worth it, since I had a 3 1/2 year old and 22 month old at home.

Here is my second son's birth story, if you are interested.

Good luck, I know it can be a hard decision to make

[IndianaMomToBe]

"DS literally would not fit out... kid had a 16 inch head and I have a small pelvis"

Since you are asking for advice I am going to ask the obvious. Was your pelvis actually examined to determine DS ability to fit?

Reason I ask is because many women are given the "baby is too big" reason by docs to justify interventions and very seldomly is a woman's pelvis actually unable to accommodate birthing a baby.

I've been physically (internally) examined since I am way tiny and my pelvis size was a huge concern for me especially since I am going for an out of hospital birth. I also have a major tailbone issue that I was worried about.

My midwife got her hands all up in there and was able to measure from bone to bone in early pregnancy to determine exactly how much space I had for birthing. From the outside my hips measured 33 1/2 inches (I am very small). Yet I have ample space between my pubic/ pelvic bones to pass a baby... and of course my hips have spread since the pregnancy has progressed.

Couple things to consider:
Your pelvic structure from the outside is not directly correlated to the internal pelvic structure. Meaning just looking at the hips and pelvis from the outside is not an accurate way of determining if your pelvis is adequate.

As the pregnancy progresses your pelvis separates and the joints even soften to allow for baby to pass through. Many women don't understand this or trust this. Baby's weight and positioning help your bones to move and separate to accommodate.

If I were you I would have an internal examination to find out just how much space you really do have in there. Also, if you are worried about a previous injury causing you problems during the birth you can see a chiropractor who will get you all straightened out and ready for the delivery.

My advice would be to trust your body and get all the cold hard facts. Don't let fear or speculation cloud your decisions especially if a VBAC is what you truly want.

[chely7425]

Yes, my pelvis has actually been examined internally to determine size. Both my previous midwife with DS and OB this time have done so, as well as the OB who did my c-section last time. I wouldn't accept the "baby too big" line without some actual proof!! I am definitely all about getting facts which is why we are working on our action plan now as opposed to waiting till 42 weeks I really wish I could see a chiropractor but it is really just not an option right now. I really appreciate all your guys advice and input!!

[IndianaMomToBe]

Originally Posted by chely7425

Yes, my pelvis has actually been examined internally to determine size. Both my previous midwife with DS and OB this time have done so, as well as the OB who did my c-section last time. I wouldn't accept the "baby too big" line without some actual proof!! I am definitely all about getting facts which is why we are working on our action plan now as opposed to waiting till 42 weeks I really wish I could see a chiropractor but it is really just not an option right now. I really appreciate all your guys advice and input!!

Man that stinks! Any chance the baby's size estimate could be wrong? I know that is often the case after the fact...

[chely7425]

Originally Posted by IndianaMomToBe

Man that stinks! Any chance the baby's size estimate could be wrong? I know that is often the case after the fact...

It defintiely stinks!! I don't know how off the estimate might be... my OB isn't estimating weight (as she puts its that is "all a crapshoot") but she is measuring the head... which is already big. All my kids are apparently destined to have bobble heads!!!!