I went into this pregnancy saying that I would never be induced again, no matter what. But as I come to terms with some of the ways that I am high risk, I have realized that there is a possibility I may have to consider it at some point, so I am trying to be as educated about it as possible. My provider does not induce without a clear medical indication. "You're past 40 weeks" is not a clear medical indication. Neither is "your fluid looks a little low" or "your blood pressure is creeping up" and some of the other reasons that OBs sometimes give. I know my OB well enough to know he doesn't induce for those reasons, though. (He is a member of my local ICAN group and has done hundreds of births for our group over the past few years.)
Pitocin is not contraindicated for a VBAC. In fact I believe even ACOG's guidelines say that pitocin okay, and a lot of what ACOG says is overly risk-averse and conservative. Is pitocin my idea of a good time? No. Last time it was torture. I wanted to die. BUT I have come to learn that not all pitocin inductions are created equal. My last one, the doctors pretty much cranked it up as high as it can go and as fast as it can go and left me alone to suffer. There is a such thing as a "low and slow" induction, and a good provider will even back off on it/turn off the pitocin if the labor is progressing. I'm still not recommending it, but all of the best hospital providers I know of (and they are a rare breed) have used pitocin judiciously at some point. For the record, prostoglandins (cervidil/cytotec) are
contraindicated for a VBAC so you should never use those. Someone mentioned the foley bulb method of induction and that is a good one, too. Here's some info on pitocin induction and VBAC
What it boils down to is for me
I'd rather go through an induction again with a trusted provider than have another c/s.
Originally Posted by kellij
Okay, so I actually talked to my dr. about this today. I was saying how I prefer not to be induced (he was talking about it b/c I live 2 hours from the hospital and said he'd rather me be induced than risk a rupture while trying to drive there). He said he would do whatever I want, but that there have been studies that show your best chance at a successful vbac is if you have the baby at 39 weeks, and then it drops a little as you get to 40 weeks and it drops off substantially by 41-42 weeks. He said it's because of the size of the babies and the placenta degrading. Now, I haven't actually seen the studies, this is just what I was told today.
?? I don't know if I buy what your doctor is saying. For one thing, uterine rupture can happen any time, not just during active labor. It can happen any time during pregnancy, it can happen during a c/s, it can even happen after the baby is born, although that's really rare. Anyway, if you have to be in the hospital to mitigate a slight chance of UR then I'd think you would just have to start living there at some point, and that doesn't make any sense! I believe that I have read something about that study about the 39 week thing, but actually your chance of a successful VBAC is higher if you go into labor on your own whether it be 39 weeks, 40 weeks, 41 weeks, whatever. So yes you have a slightly better chance at 39 weeks, but you have a much better chance if you are not induced even if it is a later gestational age! Also, what does placental degradation have to do with VBAC?! That's a pretty rare phenomenon but the chances of that happening the later you go in pregnancy are for any pregnant woman. I don't think there is any increased chance of that as a VBAC. And the chances are so small it does not indicate inducing for that reason alone.
This may be what your OB is referring to about VBAC and "big baby," but it sounds like he got it wrong. This is ACOG's 2004 recommendations on macrosomia and VBAC:
Although macrosomia (usually birth weight greater than 4,000 g or 4,500 g, regardless of gestational age) is associated with a lower likelihood of successful VBAC (28–31), 60–90% of women attempting a trial of labor who give birth to infants with macrosomia are successful (30, 31). The rate of uterine rupture appears to be increased only in those women without a previous vaginal delivery (31).
However, multiple cesarean deliveries also carry maternal risks, including an increased risk of placenta
previa and accreta (67, 68). Based on these risks, one decision model analysis found it is reasonable to consider a trial of labor if the chance of success is 50% or greater, and the desire for future pregnancy after cesarean delivery is at least 10–20% (67).
A friend of mine compiled a bunch of info about this and here is what she says (just so I don't take credit for her work):
|So even though a big baby may decrease the statistical rate of VBAC success when compared to a smaller baby, 60-90% of attempts are still successful. Frankly, with our national C/S rate hoovering about 1 in 3, even this "lower success rate" sounds pretty normal. And note that even with the "lower rate," according to these recommendations given later in that publication, it is still "reasonable to consider a trial of labor" (especially if the mother is considering at least one more pregnancy after the current one - but not only then).