VBAC Induction on Wednesday :(

[cinderella08]

I'm not 100% sure the reason of this post... I think I just need to get this off my chest and am thrilled to hear opinions, advice, and especially encouragement...

I have a history of preeclampsia. Induced at 38 weeks for severe pre-e, failed induction, and a cesarean section with my daughter.

BP has been up lately. Running baseline around 140-150/90, has gotten as high as 165/100. I'm swelling alot in my legs, feet, and hands. At today's appointment BP was high, but not too bad. Went in for the BPP and it took over an hour for Levi to "pass". He was just so sleepy/lazy. Arms and legs more lax and not moving. Nonreactive to the buzzer and poking/prodding. Fluid has dropped from 12.44 to a 7.

Saw the midwife afterwards - not my normal one, but one I really like. She had to consult with an OB because of the BP and the decreased AFI. She came back and said the OB felt I needed to be delivered. Reason being is because of decreased BPP results for Levi, low AFI, increased BP. We talked at length about the options because I was really, really upset. At first I flat told her no, I wasn't being induced unless lab work proved my body was getting sick (same as with Ava, liver/kidney failure, ect...). But she talked at length with me and gave me her honest opinion. She also checked my cervix and I've gone from 1cm, 70% effaced, and -4 station last week, to a 2cm, 70% effaced, and -2 station this week - so baby is coming down nicely and my cervix is trying it's best to "work". She feels my cervix is favorable for the induction.

We can all see that I'm getting sick and headed into pre-e territory again. Basically, I have to choose between the lesser of two evils. One - I can refuse the induction and try to wait. But, I basically am bargaining with the devil because my body is so close to full blown pre-e. If I go into full blown pre-e again and my pressures can't be controlled, it will be an immediate repeat section. If they can control my pressures, it will be a pitocin induction while on mag sulfate - meaning in bed 100%, craptastic mag sulfate for 2-3 days, ect... Plus a sick body trying to birth a VBAC baby. Or two, I can go ahead and go with the induction now while my body is still "healthy" and will most likely tolerate an induction alot better. No mag sulfate, I'll be able to move and change positions, get out of bed, ect... Realistically, a healthy mommy will probably be able to vaginally deliver easier than a sick with pre-e mommy. But it's a crapshoot basically. There are pros and cons to both choices and my heart is so torn on what to do. I'm leaning towards going ahead with the induction Wednesday though before my body gets hit hard and I have no chance.



*** UPDATE ***

Alrighty. Had a long, long, long talk with Pam - my midwife - last night. We talked through all the options, weighed each pro and con. She really helped me to feel better about everything and about the decision I made.

I've decided to definitely go ahead with the induction now. We moved it to Thursday though. Pam is on call for 24 hours on Thursday, so she'll be able to start my induction and be with me all during labor. If I don't actually deliver by the time her shift ends, she'll stay with me until I do. She knows all my wants and desires for this birth and says we'll still be able to have everything go the way I really want with just a few minor modifications (have to have continuous monitoring because of the PIT, of course have to have an IV, ect..). Going to start the Pitocin really, really, really low and keep it as low as possible. Once my body gets into a good, active labor pattern (5-6cm+) we may consider backing off the Pitocin and breaking my water to see if I continue progressing on my own. If not, she can always increase the Pitocin again.

I'm feeling much more at ease with the decision today. I've let go of all the negativity surrounding my daughter's induction. I've let go of the stigma that I have that inductions result in cesarean sections. I'm trying my hardest to make HER birth, HER birth and let HIS birth be HIS birth and not put a connection between the two just because they are both inductions. I know every birth is different and I CAN do this and I CAN birth this baby vaginally.



x-posted in VBAC and both DDC trying to seek out help! Hope that's ok...

[AtYourCervices]

*HUGS*

Try this:

Go buy a box of Herbal Medicinals Red Raspberry Leaf Tea. Boil water (about 1-2 gallons). Seep the teabags (ALL of the teabags) in the water, in the fridge, overnight. Start drinking it tomorrow morning. If your body is ready to birth, you should be in labor by tomorrow night, and you won't have to worry about the stress of being induced at the hospital.

Otherwise, go with your instincts. If you think induction is your best bet, go ahead, and don't feel any guilt.

[teamsalem]

I would opt for an induction now. The Mag Sulfate is extremely counterproductive to the Pitocin. Your cervix sounds ready enough to try to induce now. You might want to discuss a more conservative induction with your provider (i.e., if you aren't making progress after 12 hours, you can go home and come back and try again in a few days, dependent on how you/your baby's overall health is)

Drink some fluids, mama! Sometimes, increasing maternal fluid intake is enough to change a low AFI. It has been so hot, maybe youre just a bit dry.

I wish you luck! Let us know what happens

[Kelly1101]

I'd do the induction now. You've already been through so much stress and worry And I think you're right that it's better to try an induction with a healthy body than to try it while battling pre-eclampsia. Especially with having a worrisome BPP. Of course only you know what is best for you, but if I were in your shoes I'd say okay, time for the baby to come out. There is absolutely no shame in that-- induction totally makes sense in this type of situation. Especially since you're close to being faced with a repeat c-section which I can understand you don't want.

Whatever you decide to do, take care of yourself and know that we are thinking of you.

[cinderella08]

Originally Posted by AtYourCervices

*HUGS*

Try this:

Go buy a box of Herbal Medicinals Red Raspberry Leaf Tea. Boil water (about 1-2 gallons). Seep the teabags (ALL of the teabags) in the water, in the fridge, overnight. Start drinking it tomorrow morning. If your body is ready to birth, you should be in labor by tomorrow night, and you won't have to worry about the stress of being induced at the hospital.

Otherwise, go with your instincts. If you think induction is your best bet, go ahead, and don't feel any guilt.

Just sent hubby out for more RRL tea, will definitely do this tonight and drink all day tomorrow. Best to do 1G or 2G??

Originally Posted by teamsalem

I would opt for an induction now. The Mag Sulfate is extremely counterproductive to the Pitocin. Your cervix sounds ready enough to try to induce now. You might want to discuss a more conservative induction with your provider (i.e., if you aren't making progress after 12 hours, you can go home and come back and try again in a few days, dependent on how you/your baby's overall health is)

Drink some fluids, mama! Sometimes, increasing maternal fluid intake is enough to change a low AFI. It has been so hot, maybe youre just a bit dry.

I wish you luck! Let us know what happens

I'm drinking 2 full gallons of water daily, plus extra glasses of milk, juice, ect... Fluid has been borderline low, dipping into the 8-10 range for weeks, but this is the lowest it's ever been. They are almost certain it's because of the BP issues

Originally Posted by Kelly1101

I'd do the induction now. You've already been through so much stress and worry And I think you're right that it's better to try an induction with a healthy body than to try it while battling pre-eclampsia. Especially with having a worrisome BPP. Of course only you know what is best for you, but if I were in your shoes I'd say okay, time for the baby to come out. There is absolutely no shame in that-- induction totally makes sense in this type of situation. Especially since you're close to being faced with a repeat c-section which I can understand you don't want.

Whatever you decide to do, take care of yourself and know that we are thinking of you.

Thank you so much - your words really help. I am just so torn with the "what if's". What if the induction fails - I'll feel like I rushed into it and could have given myself a few more days. Or on the flip side, what if I decide to wait til - say - my EDD which is the 23rd and my body gets really sick really quick like it did with my daughter then my chances may be none.... I just feel like I can't win right now

[Kelly1101]

Originally Posted by cinderella08

I am just so torn with the "what if's". What if the induction fails - I'll feel like I rushed into it and could have given myself a few more days. Or on the flip side, what if I decide to wait til - say - my EDD which is the 23rd and my body gets really sick really quick like it did with my daughter then my chances may be none.... I just feel like I can't win right now

Yeah, it is a gamble either way... I think I remember you saying that the induction wouldn't be with cervadil, it would be with pitocin. Is your midwife okay with doing kind of a trial induction with pitocin? Just do a low dose and see if your body responds favorably, and if it doesn't, you can go home and rest some and try again later?

[Just1More]

Went in for the BPP and it took over an hour for Levi to "pass". He was just so sleepy/lazy. Arms and legs more lax and not moving. Nonreactive to the buzzer and poking/prodding. Fluid has dropped from 12.44 to a 7.

This is what stands out to me. Do it. I know you don't want a c-section, badly. But, you've got to get Levi out. He needs you to get him out and do what's best for him. You mentioned that last week his heartrate was in the 200s and had higher accels. That's way high. You CAN do this. You CAN make this about Levi's birth, and not about your daughter's. That was then, this is now. This is not HER birth. This is HIS. And he needs you.

These are decisions no one wants to have to make, or to do. I'm sorry.

[AtYourCervices]

I had a preexisting medical condition, and the OB/GYN was threatening to induce, so I decided to induce myself. I used 1 gallon (the tea was stronger, and it was more likely for me to finish it). When I induced myself using this method (at 39w1d), I started drinking the tea in the morning, I lost the plug by lunch time, and I was in labor by dinnertime. It was an easy labor, and I slept that night, between and through the contractions. I woke up at 6am or so, went to the hospital by 7am, and she was born at 9:04am.

[cinderella08]

Originally Posted by Just1More

Went in for the BPP and it took over an hour for Levi to "pass". He was just so sleepy/lazy. Arms and legs more lax and not moving. Nonreactive to the buzzer and poking/prodding. Fluid has dropped from 12.44 to a 7.

This is what stands out to me. Do it. I know you don't want a c-section, badly. But, you've got to get Levi out. He needs you to get him out and do what's best for him. You mentioned that last week his heartrate was in the 200s and had higher accels. That's way high. You CAN do this. You CAN make this about Levi's birth, and not about your daughter's. That was then, this is now. This is not HER birth. This is HIS. And he needs you.

These are decisions no one wants to have to make, or to do. I'm sorry.

Thank you so much. I know I have to do what's best for him, I just struggle. And you are right - that's something I am trying to get past. HER birth was HERS and HIS birth is HIS - just because they are both induced doesn't mean they'll both end in sections.

Originally Posted by AtYourCervices

I had a preexisting medical condition, and the OB/GYN was threatening to induce, so I decided to induce myself. I used 1 gallon (the tea was stronger, and it was more likely for me to finish it). When I induced myself using this method (at 39w1d), I started drinking the tea in the morning, I lost the plug by lunch time, and I was in labor by dinnertime. It was an easy labor, and I slept that night, between and through the contractions. I woke up at 6am or so, went to the hospital by 7am, and she was born at 9:04am.

Great - we'll do 1G of water and steep overnight and drink in the morning. I've already lost my plug and have had bleeding and heavy mucus discharge all day from the membrane sweep - was 2cm and 70%. Hopefully this may help.

Originally Posted by Kelly1101

Yeah, it is a gamble either way... I think I remember you saying that the induction wouldn't be with cervadil, it would be with pitocin. Is your midwife okay with doing kind of a trial induction with pitocin? Just do a low dose and see if your body responds favorably, and if it doesn't, you can go home and rest some and try again later?

Yea, it will be straight to PIT because of the higher risk of rupture with Cervadil.

I'll discuss doing a trial with her - it may be possible

[CookAMH]

DDCC...so sorry to hear this. I am concerned about pitocin...can you ask about doing a foley cather first and possibly breaking your water? Being a vbac that increases your rupture risk...they should know that.

[cinderella08]

Originally Posted by CookAMH

DDCC...so sorry to hear this. I am concerned about pitocin...can you ask about doing a foley cather first and possibly breaking your water? Being a vbac that increases your rupture risk...they should know that.

Yes, we (both myself and midwife) are aware of the small increase in UR risk. Uterine rupture risk in a VBAC who goes into labor spontatneously is 0.5% approximately. UR risk in a VBAC induced with pitocin is 0.7%-0.9%. UR risk in a VBAC induced with Cervadil or other prostaglandin is 2.3%. I am dilated to 2cm already and a FB is designed to inflate and fall out at 3cm, so it wouldn't help progression much. I won't consent to AROM because that puts me on a 24 hour clock. With only a 0.2-0.4 increase UR risk, I'd prefer the PIT and no time clock to AROM and a clock set...

[RedOakMomma]

I think I would try the induction, but I would try a foley first, too. Not that I'm some expert or something, but it seems like getting your cervix more open before starting pitocin might make the process easier on you and on your uterus.

I'm not sure I'd break your water before really getting a labor pattern going (though, again, this is from someone that only knows what's written in birthing books...I'm not a doula or midwife or something). I think amniotic water does a great job at helping cushion babies, and if Levi is needing a little extra cushioning in order to keep his heart tones, etc. in a good range, then maybe STARTING labor by breaking your water might not be great....especially if you're going to involve pitocin.

Can you call up that midwife you like and talk about these options? Could you try the foley and see if it kicks you into labor? From what I've read, a lot of those are put in, then women are sent home to see what happens. Sometimes they fall out and don't work, sometimes they start a great labor pattern with good dilation. I'm not sure if there's any harm in trying--best to ask.

[JTA Mom]

Oh honey, I am so sorry.

I know you feel really stressed and torn right now, give yourself at least an hour or two to grieve for the loss of your ideal birth. It is okay to be sad and panicky about going through something similar to your daughters. Totally okay. I had the pre-e, failed induction, c/s with ds too. I get panicky just thinking of doing another induction too. I think we who have been through that have some PTSD and it's okay to acknowledge it.

Right now, I would focus on controlling as many aspects as you can. If you do end up needing a c/s--what do YOU want it to be like. Write a birth plan for it. There are certain things about my c/s that were traumatizing that this time around, I will put into my birth plan.

Same with my induction.

Take whatever control you can for any of the possible scenarios. Write down what you want during an induction ending in a vag. delivery AND an induction ending in c/s (or just c/s) birth.

It won't take away the fear, but, for me, taking back some control, not being at the mercy of doctors, comforts me and calms me a bit. Maybe it will help you too?

For me, I would go the induction route. The low AFI, the low response, the heart issues, it's too much for me to risk going longer.

Also, for me, I feel like my induction was a failure because of the mag. sulfate. That sucker is used to STOP pre-term labor. Inducing is, for your body, preterm labor. I also do NOT dilate well at all lying down. Sitting up I was dilating fast, but it made the monitors required for everything go wonky, so forced onto my back.

I'd go the infusion route with the RRL. 2 oz in a pint (so 2 cups) of boiling water, 30 min steeping. Repeat repeat repeat. Make up a big batch and go for it. You want to get as much of that RRL into you as possible, which is easier to do when it's more concentrated. I'd up the EPO as well to 3000mg vaginally. Have lots of sex. Walking. Long walks at a moderate pace. Don't wear yourself out, but keep your muscles engaged.
ETA: Do you have a breast pump? I've heard of good things about pumping for 20min on, 30 min off to induce labor naturally.

And if you do end up with a c/s, please, please remember that you did EVERYTHING you could to ensure a vaginal birth. You did not fail. Sometimes our bodies know better and we are lucky to live in a time and place where a c/s is a relatively safe option. While being stitched up, the doctors found a 10cm ovarian cyst that had started turning and was about to cut off the blood supply to my right ovary AND rupture. Had I not had my c/s then, the doctors told me I would have been lucky to get to the ER in time when it did rupture in, max, 2 days. Maybe forcing the birth issue is your body's way of warning you something is up and that it needs help, be it inducing labor or safely getting your little one out in a c/s.

Ami

[AustinMom]

Okay, I know this may sound really really crazy, but it is honestly what I would do in your situation.....

1)a favorable cervix is determined by Bishop score:
http://holisticdoulanycblog.com/2010...-need-to-know/ Based on this, your Bishop score is a 4, not including the position of your cervix or the consistancy, which could bump you up to an 8, which, according to this http://intermountainhealthcare.org/s...Induction.aspx means that is ideal for a second time mom. Being a VBAC, I don't know if that would put you in the first time mom (score of 10 recommended) or the second time mom (score of 8 recommended).

Either way, if you are facing an induction or CS, I'd choose induction.

2)I know that the medical cervadil and cytotec is not recommended for VBAC, and I'd stay away from that too, you are being very smart there. Could you do sex? Or maybe shoot some primrose oil up there for those prostaglandins? I would opt for that, especially if my cervix is not as favorable as I would like.

3)Is there a possibility that you go in on Wednesday, (which by then you will hopefully be more dilated and have a higher bishop score) get the Pit induction, see how it works, if it seem to not have an effect on you, GO HOME, and come back the next day IF you and baby are looking to be in the same situation? I would opt for this as you can 'see' if it works and how your body responds. If it doesn't seem to open you up more, or progress, I wouldn't think that waiting another 24 hours would be a huge deal, but I don't know your history in detail, and it really does depend on what you have going on that day too.

Much Love!

[DoulaLMT]

Originally Posted by cinderella08

Yes, we (both myself and midwife) are aware of the small increase in UR risk. Uterine rupture risk in a VBAC who goes into labor spontatneously is 0.5% approximately. UR risk in a VBAC induced with pitocin is 0.7%-0.9%. UR risk in a VBAC induced with Cervadil or other prostaglandin is 2.3%. I am dilated to 2cm already and a FB is designed to inflate and fall out at 3cm, so it wouldn't help progression much. I won't consent to AROM because that puts me on a 24 hour clock. With only a 0.2-0.4 increase UR risk, I'd prefer the PIT and no time clock to AROM and a clock set...

Yes, you are right on. I'd go this route as well. It sounds to me like you have thought and studied this through quite well. You know, fear in and of itself produces hormones within our bodies that inhibit labor. On top of everything else, I'd spend some time meditating, focusing on positive birthing thoughts, etc. I know it's hard to trust your body when it seems to be failing you, but come up with some affirmations that work for you still. (Even if it is as simple as "I am strong, I can do this" - that could apply to many different birth scenarios.)

Hang in there mama, you've got a lot of support!!! s

[MicheleVet]

Hugs! I'd go for the induction if I were you.

[CookAMH]

Originally Posted by cinderella08

Yes, we (both myself and midwife) are aware of the small increase in UR risk. Uterine rupture risk in a VBAC who goes into labor spontatneously is 0.5% approximately. UR risk in a VBAC induced with pitocin is 0.7%-0.9%. UR risk in a VBAC induced with Cervadil or other prostaglandin is 2.3%. I am dilated to 2cm already and a FB is designed to inflate and fall out at 3cm, so it wouldn't help progression much. I won't consent to AROM because that puts me on a 24 hour clock. With only a 0.2-0.4 increase UR risk, I'd prefer the PIT and no time clock to AROM and a clock set...

Sounds like you've definitely talked through all the options. and best wishes for a beautiful birth. You can do it!

[foodmachine]

Sending s and good luck.

[Baby~Braatens~Mama]

You are in my thoughts! Sending s and .

[Lit Chick]

Sending my hugs as well!