VBAC induction vs RCS

[Tygerli11y]

Hi everyone, I am currently 38+2 and know that I have plenty of time but I want to be prepared for going post-dates. My doctor is willing to induce with pitocin and AROM and then turn off the pitocin once my body takes over. What are your thoughts on this? Anyone know the risks of vbac inductions vs. rcs?

[CherryBomb]

A "gentle" pit induction with arom is fairly common for vbac inductions. It's not something that I personally, as a vba2c mom, would consider until 42 weeks, though.

[ShwarmaQueen]

You will probably go into labor on your own, but maybe not until 40-41 wks (that's average I believe), so just 'keep on keeping on' and don't cave to an early induction offer.

If I didn't have any other options, I would take an induction for VBAC, but not until after 42 wks (instead of a RCS).

[Monkey Keeper]

I would ask for manual dilation with a foley catheter first (if you're less than 4-ish cm), then move on to AROM with pit as more of a last resort. At least, this is the plan my OB and I have agreed upon in case it is needed.

The way I look at it, an attempt at an induction ends one of two ways: a vaginal birth or a c/s. At least you get a chance at a vaginal birth this way!

Are you doing EPO and RRL to help prepare your body as well?

[Tygerli11y]

I am definately not going to agree as long as baby and I are both fine, I just want to have a plan in place. The foley catheter first sounds like a better idea, I will talk to the doc about it at my next appointment. Do any of you have experience with pitocin during vbac? Were you able to tolerate the contractions ok?

[AlexisT]

I've thought about this as I'm more likely than most to face this dilemma (high BP, previous PE) and for me it would really depend on the state of my cervix. If it's totally unripe, an induction is just not going to work. At 42 weeks, though, you'd probably have some dilation/effacement and it seems to me you'd have a better shot of success.

[kltroy]

If there's a medical reason to induce such as baby not doing well, high BP for you, etc - some good reason that baby is better out than in, I think induction is a reasonable plan so long as your cervix is favorable. If you need to get the baby out and it's clear your body is not ready it's less likely to be successful, and at that point I would ask lots of questions about *how* likely it is to work. There is probably some point at which you'd rather just cut your losses and have a RCS if it comes to that. Only you will be able to make that decision.

If everyone is doing fine then you can let the baby cook a bit longer. Remember, 95% of all babies come on their own before 42 weeks. I was very worried about oging post dates and opted to try some repeated membrane sweeps (unsuccessful - my cervix was not even fingertip at 40 weeks). There's some pretty good evidence that weekly sweeps from 37 weeks onward will reduce the length of gestation by an average of 5 days. Don't expect a sweep to put you straight into labor, but if you repeat each week, it seems to move things along earlier than they might have otherwise gone.

[mediumcrunch]

Since I've been induced as a VBAC multiple times now, I have zero problem with it. Everything from stretch and sweep with AROM to pit induction (only got up to 12mu-OB won't go past 20 for a VBAC) for Pre-e with mag on board too. It would take some pretty unique circumstances for me to agree to an ERCS over an induction.

[AustinMom]

I agree with previous no ERCS. In SOME studies pit COULD lead to higher risk of uterine rupture, but these studies don't talk about how much pit, how much natural oxytocin, etc. So there is really no way of knowing.

Knowing how even the earliest of u/s for dating (for due date) have a chance of being off by 5 days, I'd wait till 42 weeks before I did any induction, even membrane sweep, and definitely no breaking of waters.

If you body is ready for labor, it's ready for labor. Make sure baby is in good position, not only head down, anterior, but head engaged correctly in cervix, as in no asynclitism. I'd see a Chiro to open your pelvis as much as possible and align everything, and then wait till 42 weeks.