Pit & VBAC... how real are the risks??

[JFTB1177]

I have done all the reading I can and know that the risks of UR go up with induction. I will not allow any cervical gel to be used but am on the fence about pitocin (low dose). A good friend of mine has had 2 VBACs at the hospital I'll be giving birth at (and with the same practice) where they gave low dose pit, epidural, and both of her VBACs were quick and successful.

For my HBAC I was (obviously) with a MW and she let me go to 42+3 before stripping my membranes, which started my labor the next day. All was good.

This time I am VBACing in a hospital (long story as to why, don't wanna go into it here). My doc is letting me go to 42 weeks since I have a "proven pelvis" (yeah, I know). Anyway I tested GBS+ this time. The plan was to have my membranes stripped tomorrow if I hadn't yet gone into labor but now my doc (and honestly I am too) is on the fence about doing that b/c of my GBS status, even though I know the chance of transmitting it is extremely low. I am the type that just does not like to take chances.

So... if it comes down to it, how dangerous would it be to use low dose pit? Believe me, I do NOT want to!! But I want another section much less!! What would you do? Have any of you ever had a VBAC induced with pit?

I am 40+5 weeks today. Btw, maybe I should add that I have been feeling a little crampy this morning. I was also 1 cm and 50% effaced as of 1/24, my due date.

ETA: Just wanted to add too that my doula (who had been at my last birth, my HBAC) who had previously seemed so anti-induction for VBAC is now saying a low dose would not be a big deal... don't know what to believe!

[soccerchic21]

When I had my VBAC at the beginning of this month I was told my entire pregnancy that they won't induce. However, I know someone who delivered in my same city at a different hospital who was induced with pitocin. It was her second and I am not sure what the story was with her first birth which was a cesarean. 

I think it really depends on the provider. 

Because I was told I would not be induced I did all that I could to get my labor going with natural induction techniques. Thankfully they worked I went into labor 3 days after my due date. 

[AlexisT]

It's dose dependent. Augmentation has been shown to be safer than induction. IIRC, pit doubles the risk of UR from 0.5% to 1.0%.

If we're talking about the pit equivalent of a "nudge", it may not be a bad idea.

[JFTB1177]

Originally Posted by AlexisT 

It's dose dependent. Augmentation has been shown to be safer than induction. IIRC, pit doubles the risk of UR from 0.5% to 1.0%.

If we're talking about the pit equivalent of a "nudge", it may not be a bad idea.

Sorry if I sound ignorant, but what does "augmentation" mean? Like if I am already having signs of labor??
 

[jenniro]

Totally my opinion here, but I think you should avoid all forms of induction.  You went to 42+3 last time, so it seems completely normal for you to bake your babies a little longer.  Also, induction increases the chances you'll end up with another unnecessary c-section.  Don't forget that docs are trained to look for pathology, something wrong.  Also, docs have legal concerns that guide their decision making.  Not a bash on docs, they care about their patients for sure, but it is what it is.  You've done this before, your body knows how to birth a baby. 

You could discuss with the doc that you went over 42 weeks last time, so you may again this time.  Giving you a cutoff of 42 weeks and discussing induction without a medical reason doesn't seem in your best interest.  You could refuse induction but agree to non-stress tests after 42 weeks.  As far augmentation, which means giving you pit after labor has started spontaneously, is a tough call.  I think it is safer than inducing with pit, but it still causes unnatural contraction patterns. 

[buckeyedoc]

Originally Posted by AlexisT 

It's dose dependent. Augmentation has been shown to be safer than induction. IIRC, pit doubles the risk of UR from 0.5% to 1.0%.

If we're talking about the pit equivalent of a "nudge", it may not be a bad idea.

Yes, this. Induction increases the UR risk, but it is still low, so an induced VBAC may be preferable to a RCS. Pitocin dosages given to a VBAC patient would be much lower than what could be given to a woman without a scar. My VBAC was augmented with a tiny dose of pitocin 24 hours after my water broke. Labor and delivery were otherwise unmedicated and went very well. So while I would avoid pitocin if you don't need it, I was OK with it if warranted. If labor had not started for me by 42 weeks, we were going to talk about induction, but I delivered at 41+1.

Augmentation = boosting a labor that is already underway (like if contractions are far apart but water has broken, etc.).

[ComplexOphelia]

After a lot of consultation, I'm actually having pit induction on Monday after laminaria cones Sunday night to help dilate my cervix.  However, I'm having a very, very low dose of Pitocin, spread over a couple of days.  No one's expecting me to have a baby on Monday.  The slow build of oxytocin mimics what my body would do naturally.  Once we've established a good labor pattern, the Pitocin is being turned off and my body's going on its own.

My MFM, who's very supportive of VBAC, told me that the reason most people worry about Pitocin induction is because of the way they used to use Pit.  They'd run it wide open, doubling the dose every fifteen minutes, in VBAC-ing women.  They don't do that anymore - it's a very, very low dose, used very gently.  He highly recommends inducing with Pitocin over an elective repeat c-section, and I trust him with my life (and my baby's).

[maotmsmi]

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Edited by maotmsmi - 5/21/11 at 10:41am

[sharr610]

I had pit augmentation with my VBAC, but it was AFTER a double foley and AFTER breaking my water.  Once it was on, they were super sensitive to it and when my contractions got crazy strong they turned it off and I went from 7cm to delivery totally on my own.

You just have to be careful because the strength of contractions with pit increases the chances of UR.  But if its carefully monitored it can work great!

[lil_stinkyfeet]

As a side note I had my membranes stripped in 2 of my pregnancies both of which I was GBS+. 

Interestingly I was never told about an increased risk with having GBS, I did have IV antibiotics in labor both times.