VBAC and induction...

[sept15lija]

Hello everyone

I just wanted to get any opinions or information about VBAC's and the possibility of induction. I had a c-section with my DS because my blood pressure went up to 140/90 at the end of my pregnancy - no other symptoms of anything but my OB was insistent.

This time I've gone with a midwife and I am almost 30 weeks right now. At today's appointment, my blood pressure was 126/86, whereas it is normally 130/80. She is hoping is just a blip and that with some extra rest it will come down. She told me that if it continues to rise we will need an OB consult and possibly medication and more monitoring via ultrasounds. She also said I am not a good candidate for induction having had a c-section.

This last bit sort of caught me off guard, I know that induction increases risks with VBAC's but not so much that it would be something they wouldn't consider. Does anyone have any information on this? My reading has it that a natural unaugmented labour has a rupture rate of .7%, whereas with pitocin induction it is 1.2%. Obviously an increase but still a low rate. I'm in Ontario, will OB's induce a VBAC generally speaking?

I know nothing at this point is written in stone but just trying to get my information straight in case of what might happen. I am especially bummed because I am planning a home birth and this has now thrown a possible large wrench in those plans.

[HappyMommy2]

Inductions are not advised, especially in VBACs. I had a cs and then an HBAC. I would (and do) strongly advise everyone just say no to induction!

[sept15lija]

Originally Posted by HappyMommy2

Inductions are not advised, especially in VBACs. I had a cs and then an HBAC. I would (and do) strongly advise everyone just say no to induction!

So if you were in a high blood pressure situation (I'm not there yet but am trying to plan for the worst) what would your course of action be? I mean I know I am worrying about this way ahead of time, it's possible it may stay in a reasonable range, or else it can be managed by medication, but I just so badly do not want to have a c-section again I want to make sure i know all my options.

[E-man's mama]

Generally speaking, inductions aren't encouraged on VBAC's because of the slight increase of rupture rate (not to mention letting your baby come at its chosen time, your body not being ready might lead to another c/s, starting the intervention cycle, etc. etc.) But in your case, you might need to get the baby out sooner than he/she wants to come - though hopefully that won't be a concern!

My midwives were ok with some methods of inductions in a carefully supervised situation. I ended up going into labor spontaneously, but I was over my due date so we started talking "what ifs".

First thing you can try is a Foley catheter which is non-chemical and therefore poses no further risk to rupture. You could also try AROM, though that puts you on the clock. My midwives also would have done a low dose of pitocin. I know there are women here who had induced VBACs with pitocin and had a great vaginal delivery so it can be done!

I would, of course, try all the natural induction methods possible before doing any of those above, if you are close enough to your due date that they may put you into labor.

Here's to a healthy and low BP third trimester!

[Realrellim]

Originally Posted by sept15lija

So if you were in a high blood pressure situation (I'm not there yet but am trying to plan for the worst) what would your course of action be? I mean I know I am worrying about this way ahead of time, it's possible it may stay in a reasonable range, or else it can be managed by medication, but I just so badly do not want to have a c-section again I want to make sure i know all my options.

I might be in that situation, having had pre-e last time (it also was the reason for the section, but that was because it had compromised the blood flow to DD and she was in severe distress when I arrived at the hospital in labor. She needed to come out immediately and spent a week in the NICU). I'm trying to read everything I can about VBACs and induction, but mostly I've understood that other than the foley cath or AROM, induction is more risky. Most likely if my BP goes up and baby needs to come out, it will be a repeat c-sec. I'd do anything to avoid the NICU experience again though. Having a baby that could room-in and BF right away would be so wonderful after what we went through last time. But, I'm hoping my BP stays down this time and I get the VBAC too.

Sending vibes that your BP stays down

[sept15lija]

Thanks so much for your replies!

I guess my concern is I won't be close enough to my due date for natural induction methods to work. However again I may be worrying for nothing, I need to just take things as they come at this point I guess. My doula recommended I go to see a naturopath to discuss diet and herbs that may help, so I'll try that.

Realrellim - Thanks for sharing your experience, it reminds me I can be thankful for some things, DS came out with no problems and I was able to room-in and breastfeed within the first hour. I can't even imagine how difficult it must be to have a baby in the NICU - I really hope that doesn't happen to you again. Healthy BP vibes coming your way too!!

[ACsMom]

I had a section with my first, because I was very "late" and got talked into a pitocin induction, which didn't work (I spent two full days having pitocin contractions with no epidural, only dilated to 3 cm) The baby wasn't ready, that's all there was to it. So, I hear you being nervous about inducing too early. Incidentally, my BP shot up as soon as I entered the hospital for the induction, after I went the entire pregnancy with completely normal bp. I'm sure it was the stress. They monitored my bp the whole time, but no one ever said that my c-section was because of my bp. Cause of section was listed as ftp.

As far as rupture, I think you're right - the incidence increases in a vbac with pitocin induction, but it's still pretty low. If your midwife is willing to use a very low dose, along with maybe some natural methods of induction, you'd probably be just fine. Are you having any other signs of pre-e? This might not be anything to worry about right now. In the meantime there's a lot you can do yourself to keep everything under control, like making sure you're getting enough protein, supplementing with extra calcium and magnesium, staying completely caffeine-free, doing daily meditation/relaxation, etc. Eat bananas and walnuts every day - both have a soothing effect on blood pressure. There are acupressure points on the body that can help. All kinds of stuff. For me, I get stressed out just knowing my bp is going to be taken, so I need all this stuff every day to keep my stress under control!

[sept15lija]

Originally Posted by ACsMom

As far as rupture, I think you're right - the incidence increases in a vbac with pitocin induction, but it's still pretty low. If your midwife is willing to use a very low dose, along with maybe some natural methods of induction, you'd probably be just fine. Are you having any other signs of pre-e? This might not be anything to worry about right now. In the meantime there's a lot you can do yourself to keep everything under control, like making sure you're getting enough protein, supplementing with extra calcium and magnesium, staying completely caffeine-free, doing daily meditation/relaxation, etc. Eat bananas and walnuts every day - both have a soothing effect on blood pressure. There are acupressure points on the body that can help. All kinds of stuff. For me, I get stressed out just knowing my bp is going to be taken, so I need all this stuff every day to keep my stress under control!

LOL I get stressed when my bp is taken too! I don't have any other signs, just the slightly elevated bp at this point. Even with DS I never had other symptoms, just high blood pressure - and then when I went in for my c-section, my bp was 117/72! I should have refused it at that point. Thanks for the advice, I think I'll go stock up on walnuts and work on my coffee intake (usually I have a small a few times a week....no more)! Protein is an interesting one too because apparently I haven't been getting enough - my iron stores have gone down quite a bit. The midwife who said I am not a good candidate for induction is my secondary midwife, I see my primary in 1.5 weeks, so I'm going to ask her and see her thoughts on it if it should come to that.

[DocsNemesis]

Personally with just the BP issue-and with it still being boarderline high-I'd wait it out. Now, if it got worse, things were looking badly, I would opt for induction, honestly. However, I'm in a different situation since I've had 4 previous vaginal births. My only concern would be the slightly increased risk of rupture, but I'm pretty sure a little pit would get me into labor anyway. In your situation, I dont know what I'd do honestly. I just couldn't have a cesarean unless it was bad (which is why I had one the last time).

[thepeach80]

I was induced w/ my last 2 VBACs. I was not w/ my first VBAC though so maybe that's important for it working better? I was also 4 and 5 cm when I went in w/ the girls and they were born 3.5 and 2 hrs later. I personally would rather try induction over having a rcs. You can check your Bishop's Score and come up w/ a plan w/ your MW. How much pit, how long, are they going to break your water first?

[AlexisT]

It depends.

40 weeks plus with an OK Bishop's score? Assuming OB cooperation I'd try a Foley/AROM/careful pit.

36 weeks and completely unready (but baby needs to come out--say, repeat PE)? Repeat C. I know some providers will do Cervidil with a VBAC but I am really unconvinced that the risks of Cervidil on a VBAC aren't worse than the C, especially on a totally unripe cervix which might require multiple doses.

[sept15lija]

I would definitely prefer induction if things are looking good for it (as in, term or very close to it) - I'm just very concerned with the thought I may not even have that option. I need to ask for clarification, maybe she was thinking I would not be a good candidate if I needed to be induced early or something. I know the midwives definitely encourage making your own decisions, so I was surprised at the "you're not a good candidate" part of it, I sort of expected something more along the lines of education, and then I could make a decision. Hmmm...I really hope we don't get there. I'm seeing a naturopath this Wednesday.

Alexis - I agree with you, if at 36 weeks for whatever reason it is decided the baby needs to come, I would probably go for a repeat c, after all my body and the baby aren't going to be ready.

[langdonslady]

The ladies at ICAN (International Cesarean Awareness Network) and VBACfacts.com are a treasure trove of information, statistics, and also been-there-done-that firsthand advice.
I was induced for borderline BP with my first, with CNMs, and ended as a c-section.
For one thing, 40 weeks is not the normal end of human gestation, 42 weeks is, but they tell women in the US they are "overdue" if they are past 40, and a lot of inductions happen for that sorry and untrue reason.