Repeat C/S rather than induction for "non Reactive" baby??

[juliebird]

I Posted this in the November DDC but xposting here:

I'm freaking out a little here. I'm 39w 3d and because of Gestational Diabetes I've been having non stress tests weekly for 6 weeks or so. Yesterday, my doctor said the baby was non reactive (or actually he said "sleepier than I'd like") based on the non stress test (heart rate was averaging around 135/bpm versus a usual 155/bpm).

So he sent me for an ultrasound that showed that everything was fine. Baby looks to be just over 7 pounds right now, with a "rind of fat developing", plenty of amniotic fluid, all other markers for movement were fine.

Having said that, he asked me to go in tomorrow for another non stress test. He also mentioned that we'd have to talk about what to do if I don't go into labor soon. I've had one c/s and 2 VBACs previously. I'd never heard this before but he said something about how being induced isn't a good idea for women who've had c/sections before.

I did a little research and found that there is indeed an increased risk of uterine rupture for women who've had c/s before.

HOWEVER- I am not convinced I should be inducing early- or is this non reactive thing a genuine worry?

Anyone have any experience with Non-reactive test results?
What about induction after C/S?

[Storm Bride]

I can't tell you how serious the issue is.

I hate c-sections with all my heart. However, I do think I'd schedule a repeat before I'd go for induction on a scarred uterus. It is a comfort zone thing, though. I just think induction is a bad idea in most cases, and a worse idea if you have a scar.


I hope things work out okay.

[kltroy]

Think I'd schedule another NST and make sure you eat and drink something sugary before you go to hedge your bets. If baby continues to be non-reactive despite a sugar kick, you can think about how to best get the baby out. The risk of leaving the baby in is small (chances are it will all be fine) but your doctor can give you a better sense of what those exact risks are so that you can make an informed decision.

As for induction, if they use a low dose of pitocin the risks are not greatly increased. Possibly not the birth experience you were looking for, but IMHO a crappy induction beats a c/s any day. Esp. since you have already had 2 VBACs, you know your body can do it. Check the current ACOG guidelines for a reasonable summary on the risks associated with induction with VBAC -- UR risk is increased, but it is still well under 2% if I recall correctly. The ACOG document is not the most complete summary available, but it is written in a way that is fairly clear about what the evidence suggests.

[cileag]

One thing that your MD might be worried about is something called placental insufficiency, which happens more frequently with diabetes--so he might be more concerned about the non reactive stress test and your gestational age. There is a SLIGHT increase of stillbirth due to this placental insufficiency (which basically means that it doesn't provide oxygen and nutrition as well)---and I think more so after 40 weeks. Our OBs like to induce diabetic mothers at 39 weeks, which I don't necessarily agree with, but it's common.

VBAC inductions are riskier, but I wouldn't rule it out in your case, where you've had two successful vaginal births and so you should hopefully respond better to the various methods for induction.

[trekkingirl]

I would just take castor oil. Worked for me with my last vbac!

Ask your OB to sweep your membranes and then go home and take castor oil, IMO. That's what I did.

[juliebird]

thanks everyone for your responses. I appreciate hearing from you very much. I am going to do as suggested and check the ACOG guidelines.

He already swept my membranes yesterday but noting much happened. I had increased cramping and more frequent BH last night but nada today. Nothing.

[turnquia]

From my understanding and I was just at a birth not long ago where this was the case.

A baby with a non-reactive stress test means there is a form of distress going on in that baby. (So keep on top of kick counts) In a baby who is physically active and still has a flat heart rate it can be even more distressing. When we move and are active our heart rates should go up, this includes a baby in the belly.

If you induce a baby that is already stressed then it will most often just end in an emergent c-section, because the stress of labor (even a natural labor) will further stress the baby. Also an induction is generally not advised for VBAC's because of the large increase in uterine rupture associated with inductions/pit.

My friend had a 28 weeker who was a rushed c-section. Turns out she had an old placental abruption that was just getting worse and baby wasn't doing well. I knew it meant immediate delivery by seeing her non-reactive strip plus the additional things she had going on.

So if I were you I may ask a high risk ob their thoughts prior to doing anything but your OB may be on to something if your baby really was non-reactive

[MsBlack]

You've heard people's opinions and some info...I just want to say--baby might simply have been sleeping deeply. They often do in later pregnancy, at least some hours of every day. I would try to get the next NST scheduled for a different time of day--and yeah, you might try drinking something sweet first.

[~pi]

Just a diabetic tip (I am type 1): If you don't want to deal with the BG effects of a sweet drink before the next NST, try something really cold. A big glass of ice water always got DS going.

It's important to make sure that those kinds of tests are accurate, so I always tried to time them for times when he tended to be moving around, and also made sure to do something to encourage him to be awake. It's hard to get an accurate read on a sleeping fetus.

Wishing you all the best.

[elisheva]

Pitocin does increase your chance of uterine rupture on a scarred uterus, but the real enemies are the cervidil and especially cytotec. If your cervix isn't ripe on its own and baby needs to come out, I would opt for the c/s. I'm not even sure I would try the pitocin, but that's just me. And I hated my c/s. 

[MsBlack]

Juliebird--

Any updates???  Hoping you both are well!
 

Originally Posted by juliebird 

I Posted this in the November DDC but xposting here:

I'm freaking out a little here. I'm 39w 3d and because of Gestational Diabetes I've been having non stress tests weekly for 6 weeks or so. Yesterday, my doctor said the baby was non reactive (or actually he said "sleepier than I'd like") based on the non stress test (heart rate was averaging around 135/bpm versus a usual 155/bpm).

So he sent me for an ultrasound that showed that everything was fine. Baby looks to be just over 7 pounds right now, with a "rind of fat developing", plenty of amniotic fluid, all other markers for movement were fine.

Having said that, he asked me to go in tomorrow for another non stress test. He also mentioned that we'd have to talk about what to do if I don't go into labor soon. I've had one c/s and 2 VBACs previously. I'd never heard this before but he said something about how being induced isn't a good idea for women who've had c/sections before.

I did a little research and found that there is indeed an increased risk of uterine rupture for women who've had c/s before.

HOWEVER- I am not convinced I should be inducing early- or is this non reactive thing a genuine worry?

Anyone have any experience with Non-reactive test results?
What about induction after C/S?