Choosing between repeat C and Pit induction...

[SarahKatN]

This isn't a decision I have to make right now, but it's something I need to think about. Here's the deal. I'm 40 weeks tomorrow and tightly closed. I thought all induction was contraindicated in vbac, but my ob did say they would consider Pitocin (NOT cervadil, not sure why....) if my cervix was already favorable. That worries me; I'm not thrilled about doubling the rupture risk. However, is it still preferable to a repeat C? At this point, it's not even an option since I haven't started dilating at all, but suppose I go in next week or the week after and I'm a 2 and they say induce or cut. What would you do?

[lovelymomma]

ask for a minimum of another week... depending on dating, baby may not be truly 40ws, some go over a week, how does babys weight look (how are you measuring) are they expecting a bigger than "normal" baby, for instance mine were 38wks and 9lbs15oz and 8lbs12oz.. HUGE for 38wks and COVERED in vernix so it wasnt that my dating was off, was just that all 70lbs gained wasnt helpful for either of our weights lol.. some women just go late just as some women have big babies.. ask if they will give you more time before you induce... especially considering there is an added risk.

I havnt been there but i do know PLENTY of women who go later than 40wks for one reason or another. As long as neither of you are in danger I would be asking for a week at least.

[kltroy]

I was in this exact situation almost exactly 2 years ago (my daughter's birthday is the 21st of this month). At 41 weeks I asked for a NST, which I had at 41+1 days. Happily, that AM I went into very early labor but went to my NST appt because I wasn't sure it was really going anywhere at that point. NST showed a happy baby but very low fluids (2 I think?) and I was sent straight to L&D and told that I needed to have my baby "soon" (this was redefined as "within 24 hours"). I asked lots of questions and came to the conclusion that I agreed, we were at a point where baby was better out than in.

I would have consented to a pit induction, had it been necessary. Happily my labor kicked up a notch during the decision making process and I was able to convince them to simply monitor me for the next 6 hours and augment my labor only if it didn't seem to be progressing on its own. It did, and they left me alone, so I was able to have a really nice intervention-free VBAC.

Anyway, my point is that a NST will let you know how the baby is. And from what I've read (which was a lot, as of a couple years ago) pitocin is pretty safe for VBACs, and even cervidil appears to be safe when used judiciously. (who'd have thunk?) If you get to a point where baby is better out than in, a crappy induction beats a repeat c-section, IMHO, assuming your cervix is favorable. If you get to that point and your doctor says "I really don't think this induction is going to be successful" and you believe her/him, you may want to opt for the repeat c-section, as heartbreaking as that is.

[GOPLawyer]

I would tell them to take a flying leap. There's no reason to induce or have a RCS just because gyou're past 40/41/42 weeks. Even the ACOG doesn't recommend a RCS just for going past 40.

And never forget...the decision is yours...not theirs. Don't "ask" them...tell them.

Also...cervical checks don't tell you anything other than where you are at that exact moment. You could into labor and have the baby tonight. All they serve to do is possibly introduce bacteria.

[_ktg_]

Originally Posted by SarahKatN

This isn't a decision I have to make right now, but it's something I need to think about. Here's the deal. I'm 40 weeks tomorrow and tightly closed. I thought all induction was contraindicated in vbac, but my ob did say they would consider Pitocin (NOT cervadil, not sure why....) if my cervix was already favorable. That worries me; I'm not thrilled about doubling the rupture risk. However, is it still preferable to a repeat C? At this point, it's not even an option since I haven't started dilating at all, but suppose I go in next week or the week after and I'm a 2 and they say induce or cut. What would you do?

I would ask when they would like to see me next for an appointment or if they want to start having me do NST along with another appointment. Its the nice way of saying - I don't want your induction thx!
If the question still comes down you need to induce or RCS, with a tightly closed cervix, then I would have lots of sex, use some EPO and walk my tookus off in a mall or outside. Are you having any BH ctx?

You have many options instead of inducing with PIT, and I would be asking for a Foley Bulb first before even heading down the road to PIT. I would also consider accupuncture as a start to see if my body was ready to labor.
Lots of things can change in a week and who knows?

Its what I did with my second when I went into for an induction at 42w.

[CookAMH]

If I were in your shoes, I would not show up for any induction that they wish to schedule. How long will they *let* you go? 41 weeks? Two weeks is a LONG time to have to go into labor, and no induction should occur before 42 weeks if the baby is doing fine.

[Faliciagayle]

You do not have to choose between induction and c-section.

Being at your estimated due date is not a reason to allow or consent to either.

EDDs are a statistical measurement, and the 40 week EDD means anyhere between 38 and 42 weeks is normal. Ergo, only delivery past 42 weeks puts you in real "post dates" position. Both of mine were born at 42 weeks.

Are you in touch with your local ICAN chapter?
Have you searched the forums here? There is a lot of information available on this forum and on the net.

Consider searching Michel Odent, OBGYN and RCS and see what you find.

Repeated cesarean sections are riskier than vaginal birth after cesarean.

[CEG]

Low dose pitocin inductions and augmentation are generally considered safe. I have never heard the statistic that it doubles your risk of rupture- in fact as far as I am aware it increases your risk only very slightly.

Personally I would also go the NST/BPP route as well. I would consider induction if there was a valid medical concern or at 42 weeks. I would absolutely choose induction over a scheduled repeat c-section (assuming a prior low transverse scar, vertex baby, etc,).

I am a CNM and have worked with women in this situation who had great VBACs with pitocin augmentation and induction.

[SarahKatN]

Thanks, everyone, for the input. To answer some questions, I'm a "great vbac candidate", as my doctors have said (prior vaginal birth, low transverse scar, reason for c/s was for fetal heart decels, etc etc). I know I can do it. I'm just so frustrated that my body isn't getting in gear yet. My doctors are completely fine with 41 weeks, 42 might be more of a stretch but I was actually impressed with the overall attitude at my appt today.

Nothing has been decided, but I was curious what was preferable, the repeat C or the Pit induction, since all along everything I've read has said to avoid induction with vbac.

[lovelymomma]

glad to hear the good news

[mom2happy]

I have to type fast- baby is about to wake up, but wanted to respond.
This is just my experience. I was faced w/ this decision 7 weeks ago.

I found a doc who was willing to do vba2 and he was very optimistic.
At 40 weeks he said I could have 1 more week, baby was huge, etc.
At 41 weeks I had been in labor 2x with major contrax that came every 10 min for 24 hrs both times.
The third time the pains were going through my pelvis down my legs.
Went to hosp- he talked my into breaking my water. 14 hrs later he wanted to start pit. I had always said if I was faced with that I would just say forget it.
I was set on getting the baby out vaginally and really thought it was going to happen so I said ok. It was terrible. the pain was excruciating and wasnt dilating me past 4 just like my first baby. I got the epidural (which was the other thing I told myself I would never do)
Then, even with the epidural I started having knifing pains with each contraction along the left side of my scar.
That was that
I ended up with a third c/s and couldnt hold or feed my baby for 4 hrs because of convulsive like shaking from shock and all the crap in my sytem.

Again, I just wanted to share my experience. I know pitocin has worked for some vbacs, but this is exactly why I said I wouldnt let them do it and exactly what happened.
I was extremely upset especially because I actually did go into labor and was having such huge contractions.

I have to add, so this isnt a completely miserable post,
that I am over it (almost) and so in love with my big beautiful baby girl.
Im at the point that Ive stopped being mad and hurt and have to get on with life. Every day is amazing and Im grateful for this life.

[spu]

don't schedule a c unless there is a real medical emergency to do so.

don't schedule an induction unless things are already heading in the right direction.

if you must choose, go for the induction.
but before you agree, buy yourself one more day, and another, and another. ask for NSTs, biophysical profiles, etc. to make sure there is no real reason why they want to get the baby out so fast.

you can do an induction as a vbac'er, but they'll monitor you very closely (request an IFM - gives you much greater freedom of movement!) and they may keep the amount of pit at a lower limit. remember that as your contrax go up (imagine the 'wave' rising and falling), the baby's hr will go down and up in the opposite direction.

also if you agree to an induction, make sure prior, that they check your cx to make sure it's showing favorable signs. doing an induction 'cold' when nothing else is ready really doesn't help in moving things along in the right direction. if you go for a biophysical, drink loads and loads of water or you'll get a false "low" reading on the fluid in the sac.

my stories are similar to pp.

my first pg was with twins (after 4.5 mos bedrest - that's a different story, but i was completely out of shape.) I was oblivious to anything and everything, and agreed to an induction. i was about 2.5 cm when i went in. flat on my back. two internal monitors, nothing to eat or drink, including no ice or water (how horrible!!), a bunch of epidural meds, including bolus shots. and guess what happened. yup. my first c.

my second pg was with a mw and doula. everything was perfect. prenatal care. positive. optimistic. at almost 42 w, and after several sweeps, nothing was going on, so i did the castor oil technique, which was somewhat successful, despite the fact that i accidentally took half the amount so the effects were not as strong as they could have been.

went to hospital, labored all natural (a great labor, actually!) got to 10. and things petered out. little did we know, DS was 10 lbs 3 oz, and posterior, and asynclitic (sp?). so even after a nap, pit drip, and everything else my mw and doula could try, i ended up with another c. *** hence another reason to check your babe's position prior to agreeing to start anything.

baby #4 was my vba2c story. i went into labor on my own 2 weeks early, and had a natural med-free intervention free vag birth. didn't even have a hep lock or iv since he came out so quickly. he was 8 lbs 10 oz.

so in addition to your own body's readiness, your baby's readiness must also be aligned with the stars, so to speak.

keep asking for frequent tests to make sure there is no reason to rush. if they see anything, then go for the induction. or ask about castor oil. avoid the cohosh herbs - they can cause contrax that are too strong and irreversible for a vbac.

good luck and keep us posted!

[Carolinamom4]

I had a VBAC with my last (second DD was breech c/s). They did use a little pit after I had labored with what I thought was little result (versus my first labor which was much quicker and effective) for about 18 hours. It was fine, but I did get an epidural after pit. Good luck! I want to avoid a RCS and absent too big a baby I think I will.

[AlexisT]

If I were at the point where my choices really were induction or RCS (because I felt the risks of waiting it out were greater than the risks of immediate delivery, not because of OB pressure/unrealistic deadline) AND I were a candidate for a pit induction, I would choose the induction. I had my CS because induction was not an option, and I will always wish it had been.

[mamalade]

I would not agree to either unless there was a real reason. I had pit augmentation for my first baby 9 months ago, and 6 hours on the pit caused enough fetal distress to cause a c-section. I would stay away from it, and def don't schedule another c/s just because of dates! Just my opinion
Good luck, I hope that you go into labor on your own very soon. Our bodies and our babies don't know how many weeks it has been, they only know when it is time. Please don't let them rush you. Your body is a LOT smarter than they are.

[MissE]

I did agree to a low pit induction at 40+3 with DD. BUT my cervix was at 6cm and 80%. They started the pit, broke my water and baby was there only fourty minutes later, no time for an epi.

Good luck

[mizznicole]

I'm convinced that my DS was late because of poor positioning (which led to cesarean). So while I agree that some babies just take their time, I also think that it can be a sign of something being off. In my case, DS had all the signs of being past his due date (mainly the peeling vernix).

Not sure what to tell you except try washing all the floors in your house on hands and knees!

[SarahKatN]

Thanks for the stories! I am trying everything to get going on my own so it's a moot point (I did have some strong contractions from 3am-4am so I am just praying that things are happening!!).

MIssE, your induction in particular sounds fantastic!

[roadfamily6now]

Originally Posted by GOPLawyer

I would tell them to take a flying leap. There's no reason to induce or have a RCS just because gyou're past 40/41/42 weeks. Even the ACOG doesn't recommend a RCS just for going past 40.

And never forget...the decision is yours...not theirs. Don't "ask" them...tell them.

Also...cervical checks don't tell you anything other than where you are at that exact moment. You could into labor and have the baby tonight. All they serve to do is possibly introduce bacteria.

Totally!

[SarahKatN]

Well, I'm happy to say it was a decision I'll never have to make! I went into labor yesterday (40+1) and barely made it to the hospital in time to deliver my little girl! I'm thrilled I had my VBAC and that everything worked out I'll share my birth story soon! Thanks for all the input!