VBAC Induction/Unfavorable Cervix?

[DocsNemesis]

I'm 35 weeks along today and facing a possible induction in the next couple of weeks due to pre-e. I'm in the hospital on bed rest and I've been told that as soon as my labs start to go downhill, they want the baby born.

However, as of right now, my cervix is unfavorable. I know the gel and such are a no no with VBAC, along with most other methods. I was told with my last babe that the would do a foley catheter to about 4cms and then go from there. Has anyone had a foley catheter to start induction? I'm just wondering what the chances are for that working and how bad it is, lol.

Also, knowing that I HAVE to deliver within a set amount of time, one way or the other-I was thinking that having my water broken at that point would probably be better than pit, as I know pit is contra indicated in VBACs. They do use pit on VBACs here, which is why I'm asking...I want to minimize our risk and I've had great luck when my water was broken before BUT that was during a natural labor. Inducing early like this, I have no idea what would happen.

I want to induce if she needs to be born, period. I know that. I just don't know what the *best* method would be. Even if it fails, I'd much rather try than just sign for another cesarean. Anyway, any advice is greatly appreciated

[mediumcrunch]

So sorry about the PE. It can really make a VBAC tough going.
The foley plus AROM then pit is probably the way to go. If they mag you you can almost count on pit since along with the smooth muscle relaxation that brings your BP down it also relaxes your uterus.
I had a PE VBAC two babies ago. At one point I cried to my husband and doula "This is not how I give birth!! I look like I'm having a heart transplant not a baby!!!" (referring to the 4 IV bags, two pumps, foley, monitors etc...and I did not have an epidural to add to that)
A VBAC with PE is tricky but doable. Give yourself room to grieve the 'normal' vaginal birth that you have to let go.

You have some time, could be hours, days or weeks. Let's be positive and say you have weeks. Get some EPO and start taking it orally and inserting it vaginally if your OB won't have a total freak out about it. You are a multip, the chances are good that your cervix will start to ripen in the next week or two, better if you give it a little help with the EPO. Every little bit of effacement and dilation is a step towards a successful induction.

[DocsNemesis]

Well, thats actually another issue, I dont actually HAVE an OB. I've been seeing whichever random OB is on call each day, which means what I'm being told is going to happen, how worried they are, etc, varies from day to day.

I'm in the hospital on bedrest, but I'll still try to do the EPO. I'm not having cervical checks at this point so it shouldn't be an issue. I do agree that every little bit helps-and with me being on bedrest, I don't think my cervix will be doing nearly as much on its own as it normally would.

The thing is, I had HELLP with my last baby and they're uber paranoid as a result. I don't think I'd be in the hospital if it was just typical pre-e, as its very mild at this point. My bp's are all fine and my urine dips are fine, but I failed the 24 hour urine test and my platelets are a wee bit low-not bad and staying steady (around 130). So I'm basically waiting to start going downhill I guess...but then I dont know that I want to wait until that point, as there was no time last time to induce and I really don't want another cesarean if I can avoid it

[mediumcrunch]

If your BP and labs are good you probably have time although with a history of HELLP I don't have to tell you that can all change fast.
I *hate* PE.

(((HUGS)))

[AustinMom]

What about having your membranes swept instead of broken? This would keep (hopefully) your bag of water intact, so it's not as uncomfortable, and you still have that in your back pocket if things don't progress well, to break your waker that is. If you have had success with your water broken before, I would think that a membrane sweep would work, maybe not as well, but work well enough to get things started without a time limit. Also, I hope you know that it's 24 hrs after the first vaginal exam that your risk of infection goes up.

Primerose oil is full of prostaglandins, maybe use that directly on the cervix, as it can help with cervix ripeness, but not in a harsh way. I'd ask a MW first on that though.

Happy Birthing!

[AlexisT]

It's really hard to induce on an unripe cervix without prostaglandins. You can use pit with caution on a VBAC but you need to be favorable for it to work.

Sweeping on an unripe cervix may not do much (they tried it on me).

The thing is that at 35 weeks, they're going to prize keeping the baby in as long as possible over giving you the time to induce, and it's not a bad calculation. I had my CS for PE with an unripe cervix.

I'd try EPO, and if you do get the time, a Foley.

[kltroy]

This is very tough. Your best bet is to try and keep your BP under control to let that baby cook as long as possible. If you're dilated at all, try a membrane sweep, or a series of sweeps, each a few days apart, to try and get your natural prostaglandins working. If you get to a point where the baby needs to come out, I'd go for AROM and a foley, followed by gentle pitocin. Pit actually didn't increase risk of rupture by too much, and augmentation is less risky than induction. Best of luck. Your situation sucks - I'm sorry.

[channelofpeace]

It can be done!!!

My first vba2c was induced at 37wks due to blood incompatibility. Unripe cervix. Foley, nipple stimulation, eventually AROM. Never needed pit even. My birth story is somewhere in the birth stories forum here. It took a loooooooong time, but we did it.

I hope your blood pressure stabilizes and you don't have to be induced though

ETA: I think that pit is contraindicated for inducing vbacs, but not necessarily for augmentation once labor has started, if that helps at all.

[JessicaS]

It can be really difficult to get so far and have the rug pulled out. I hope things go well, or that you can have a peaceful surgery if it comes to that.

[DocsNemesis]

Well, I got sent home and I'm being monitored closely-if anything changes I'll be right back in the hospital, but they are really hoping I can stay home as long as possible.

The plan right now is to keep her in as long as its safe. If I get seriously sick like last time, I'll be having another cesarean-which honestly, I'm fine with. I couldn't imagine laboring like that (my liver and kidneys were failing and I was in a LOT of pain from my liver, along with mag making me sleepy as heck, and my bp being through the roof making me feel even sicker). If things start to go downhill but its not as serious, they said they *may* try to induce. I'm going to insist on it though, provided their reasoning isn't something more than "your cervix isn't ripe so we don't want to even try." I am using EPO now that I'm home as well-I know from experience that for me, it does help, a lot. I managed to accidentally put myself into labor with my 3rd at 37.5 weeks with that and a cervical check, lol.

Anyway, I hope I can make it to 37 weeks and then at that point, hopefully my cervix will have ripened a bit and a membrane sweep will be all it takes I may, depending on how things go, try to keep her in there a bit longer though. I'm sure if I'm not getting worse, the best place for her to be as long as possible is in her cozy little house.

[mediumcrunch]

So glad to hear you are home!!!
keep us posted with how you are doing.

[JayJay]

With me, all it took at 40 weeks was a membrane sweep -I was only at about 1.5 cm at the time. Labor kicked back in and that was that, to cut a long story short! We were going to do the whole pit thing but got about 4mcg into my arm before she was born - so it didn't even take effect! I did go the AROM route at 4cm. She was born 7 hours later, give or take!

[DocsNemesis]

I think now my major concern is that with me being on strict bed rest, is my cervix even going to dilate on its own at all? I mean, I'm usually pretty active, up and about, taking care of the kids and the house, going shopping, etc. Now my activity is limited to walking to and from a bathroom.

I am getting a prescription for a home BP cuff, so I suppose I can keep track of my BP and see how much I can actually do without making it go nuts. I just have a hard time seeing my cervix ripen much with no gravity to help....am I wrong?

[JayJay]

Cari, don't panic. Toward the end of my labor, my cervix dilated 3cm in an hour while I lay on my side. So it's not all about gravity!

Now to help along though, would you be allowed to bounce on a birth ball from time to time? It's a gentle activity, for sure - nothing like running about crazily - and that would get you upright on a soft surface. Maybe ask about that? Altogether though BELIEVE in yourself - it can only do good! Think "open, open, open" if you want to open, and it will help you before, and during labor. That's what I was thinking - "open, open, open" as I lay there on my side feeling my contractions open up my cervix. It worked!

You CAN do this! Have faith in your wonderful body - we who have been through a VBAC successfully are no more "special" than you - but, we're on the other side of the experience, that's all! I think you can be very successful

*HUGE hugs* XxXxX

[DocsNemesis]

Oh, I'm not worried about my ability to birth in general...I mean, I've had 4 vaginal births before my cesarean. And the fact that its a VBAC in itself doesn't worry me at all. Its the whole not moving around thing that worries me.

Having said that, I started EPO the night before last to help things along. The first night my cervix was thick and puffy. Last night when my fiance went to put the caps in (I can't reach my cervix at all laying down down so he's putting them as close to my cervix as possible for me), he couldn't find my cervix at first. Its because it had totally thinned out and wasn't puffy anymore. Its still closed, which is fine atm, but the fact that its thinning out gives me hope! I also generally walk around for weeks dilated to at least a 4 so if I do start dilating, I'm not too worried about going into labor early.

Oh and I've been ok'd to dtd, allbeit cautiously, so that might help too!

[DocsNemesis]

Nevermind this post! My cervix is no longer unfavorable. EPO worked its wonders and I'm now completely effaced and 3-4 cm's dilated O_o

[Mom2M]

Wow! Good luck!

[JayJay]

Originally Posted by DocsNemesis

Nevermind this post! My cervix is no longer unfavorable. EPO worked its wonders and I'm now completely effaced and 3-4 cm's dilated O_o

Yay Cari! You'll do great! Since they were in fact trying to slightly induce my labor and I had a hospital birth (because of what happened with Josie) in which VBACs are only allowed during the day (unless you show up pushing) they actually broke my water at 4cm and she was born about 7 hours later! So I remember being 4cm with Bella!

Hope it all goes wonderfully for you! XXX

[DocsNemesis]

Oh wow, they only allow VBACs during the day?! Thats nuts! So many women deliver in the middle of the night, thats sad What do they do if you have a long labor, get to 10cm's in the middle of the night? Send you for a cesarean?

Anyway, we're going to strip my membranes this weekend and see what happens. I'll be *almost* 37 weeks, but my bp has been getting more unpredictable and I'm afraid to wait too long. Plus my kids will all be at their dads this weekend so that helps!

[JayJay]

Stripping my membranes started full labor back up for me.

I think at 10cm in the middle of the night, they'd let you push. But at say, 3cm, they'd want to do a cesarean. So for that reason we timed it pretty well - my birth story is in my blog if you want to see - a combination of timing and luck!

XxX