Would you have an induced VBAC or a repeat C/S?

[minkajane]

This is just a worst case scenario wondering. I am 38+5 with #2. In the unlikely circumstances that I make it to 42 weeks without going into labor, I will be facing the choice of inducing or having a repeat C/S. At this point, I have no clue which I'd choose. I know that Pitocin increases the risk of rupture somewhat, but I also know the risks that come with a repeat C/S. It's a tough choice.

What would you choose and why?

[kltroy]

i would choose a very gentle induction, ASSUMING my cervix was somewhat ready to go.  If my body showed no signs of being ready to labor and the induction was going to be difficult and have a low probability of success, I might cut my losses at that point.  But if a pit only induction seemed likely to work, it would be preferable in my mind.  A crappy induction beats a c-section any day in my book.  But I say that having never had a crappy induction (if that was your first birth experience you might have another opinion!)  I was facing this choice when planning my VBAC a few years ago.  I decided that starting at 39 weeks I'd do repeat (weekly) membrane sweeps to try and move things a long.  Also tried regular sex (at least 2-3x/week) starting at 38 weeks.  And I decided that if I got to 42 weeks I'd drink that castor oil.  Thankfully, my baby was born vaginally, on her own, at 41+2.  Good luck!

[Monkey Keeper]

Having been faced with the same decision (went into labor at 41+1 though), my strategy was:

- membrane stripping

- acupressure

- massage

- chiropractic

- acupuncture

All of these were scheduled for 41 and change.  I actually had the first 4 the day before I went into labor and kept my already-scheduled acupuncture appointment when I was in early labor.

Then if those did not work in getting things started:

- Foley catheter

- nipple stim via breast pump

- amniotomy (if baby was fully engaged)

- very, very conservative "whiff of pit" with CEFM

We would have turned the pit off when my body took over. My OB and I agreed that a cautious pit induction without pain meds still had less risk than an RCS.

I also think a consideration is whether you want more children. Since this would be your 2nd c/s, you'd likely have a difficult time finding someone to attend VBA2C, regardless of the current ACOG position, correct? 

ETA--And to address kltroy's "crappy induction" theory, I had 2--one resulting in an assisted vaginal birth and one that "failed" with an intact BOW so home I went.  And I definitely vote induction :)

[AlexisT]

If I were favorable, induction. They're really limited in what they can do with a VBAC, so I'd think you're more likely to have a complete bust than one of those over the top painful inductions.

If I was still completely unripe, I'd probably go for RCS.

[pacificbliss]

I had a VBAC but my plan was to go to a repeat C-section over a pit induction. I labored 46 hours with my son, labor started spontaneously. At 38 hrs we tried pit, 42 hrs I had an epidural, 46 hrs I had a c-section. He was average size but with a large head that was asynclitic. When I got pg again I wanted a VBAC. The midwives and hospital were supportive. I could not face trying so hard for so long and failing again. I decided if it was right I would know. If labor did not seem right, rather than start down the road of interventions, I would just take charge and get the c-section. That's just me though and the right decision for me. I went into labor at 38 +2 and had the VBAC.

Good luck!

[Zimbah]

I've been thinking about the same thing, I'm 39 weeks today.  I would go for a repeat CS at 42 weeks rather than an induction.  I'll try a membrane sweep or two before then, but no intervention beyond that.  This has been praying on my mind since a registrar told me at 36 week appointment that at 40 weeks I'll be booked for an induction at 40+12.  I said no I wouldn't, I don't want to take the increased risk of scar rupture that comes with induction (I also don't want the cascade of interventions that's likely, but I didn't think she'd be interested in my arguement on that side of things!).  She said I would not be allowed a CS which I was as I don't think that's actually the hospital policy.  Anyway my plan is to book an appointment with the consultant for 40 weeks and be very clear that I will not be going in for an induction so they'll have to offer me a CS!  But that's how I feel.

Of course my much preferred option is for baby to get a move on and come naturally (went into labour with DD1 at 38.5).

[cinderella08]

I was faced with this choice.

In 2008 I was induced due to HELLP syndrome (severe preeclampsia resulting in elevated liver and kidney functions). The induction failed, resulted in a c-section.

In 2010, I developed preeclampsia again while pregnant with my son.  My cervix was not favorable.  I was 25% effaced and closed completely.  I still opted for a gentle pitocin induction.  I had a short, pain medication free, 7.5 hours labor and 1/2 hour of pushing and an amazing VBAC. 

I would feel as if I didn't give myself the benefit of at least trying if I had just opted for a RCS even though I was getting very sick with preeclampsia again and my cervix was very unripe.

[~Amy~]

I opted for an induced VBAC last week.  I had pit & then had my membranes ruptured after about 2 hours.  He was born 3 hours later after about an hour of pushing. No pain meds (other than one whiff of the gas, which made things worse, not better).  Even though I had some tearing and also bled quite a bit, resulting in the OB needing to go in after some retained tissue (OUCHY!), the recovery has been so much easier than it was after my C/S.  I would make the same choice again.

[jenniro]

My personal choice, as a result of 2 tol that ended in c-section, is I would not induce and I would not do a RCS.  I would have NST and bio profiles after 42 weeks to make sure babe is doing fine, but other than that, I would wait it out.  I will only consent to a c-section or induction for medically necessary reasons.  My body does not respond well to induction, of any kind, natural or otherwise, so I have learned my lesson the hard way.  We will be TTC this summer and I am planning a HBA2C with a very hands off approach. 

[4midablemama]

I had a VBAC at 40 weeks on the nose. My labor started on its' own, but I spent nearly a week in prodromal and then another 48 hours in true labor before my son finally made his arrival. My labor stalled several times while I was in the hospital; the third time it stalled, I was fairly certain that I was headed for a C-section, because the doctors were getting antsy and I had been told that pit was a major VBAC no-no. Luckily, I had a very wise nurse who convinced me in situations like mine, pitocin, used with caution and in very small doses, could be helpful and she was right on the money. We tried the pit and my son-8 lbs. 11 ozs. and with a massive head-was born vaginally a few hours later.w

[lawmama1984]

I would probably start with some natural induction techniques, personally.  I plan to do this starting around 38 weeks with my next.  Obviously, that early would just be things like lots of sex, continuing an EPO regimen that I will probably start around 36 weeks, and listening to a Hypnobabies "Come Out" Track.  As I get closer and closer to 40 weeks, I will probably step it up with chiropractic care, acupuncture, etc. and other things my midwives might suggest.  This is a really personal decision though, I think, and a lot of my reasons for choosing to try to go sooner rather than later has to do with the fact that I don't feel comfortable going past 42 weeks and I also grow pretty large babies, so I would prefer to go earlier.  Good luck and keep us posted! :)

[minkajane]

Originally Posted by lawmama1984 

Good luck and keep us posted! :)

I never did update, did I? Well, I had kind of a deadline because my sister was coming in the day after my due date just for one day, so I really wanted her to see a baby, not a belly. I did black cohosh, walking, nipple stim, membrane sweep, then finally after my second night of CLO, I was awakened by my water breaking! I had a fast fast fast labor, ending in emergency C/S because DD was single-footling breech. The full story is here at my blog. DD just likes to keep us hopping I guess - she came on her due date and got out of the special care nursery about 2 hours before my sister departed, just in time to meet her aunt!

[lawmama1984]

How do you feel? Emotionally and physically? I hope you are recovering well and enjoying your sweet babe. Much love

[minkajane]

Originally Posted by lawmama1984 

How do you feel? Emotionally and physically? I hope you are recovering well and enjoying your sweet babe. Much love

Recovering very well physically. Emotionally, I am of course disappointed that I didn't get my VBAC, but I don't have the what-ifs that I had with DS since I know this one was 100% necessary and there was nothing to be done. I adore my DD and I'm thrilled to have an excuse to buy all those cute little girl clothes I've been drooling over.

[lawmama1984]

Love it! I am so very happy for you. I went to your blog and read the story and saw pictures. She certainly is a beauty!

[LisaSedai]

Congrats! Happy Birthday Abigail! Girl clothes *are* fun, someone gave me a piggy bank at my baby shower with a note that I should start saving up for that prom dress in her future LOL.

I'm sorry you didn't get the VBAC you planned, but since your c/section was truly needed this time  I hope that makes it easier to deal with. Heal well!

[Lisa1970]

I know you already had your baby, but I thought I would still answer.

Induction, for sure. Another csect just leads to another csect which leads to another and so on. Each additional csect has higher risks and the recovery on average gets worse. Some people it does not get worse, but for a lot of people, it does. With my last csect, I almost died. I was in the hospital for almost 2 weeks. I was in pain for months, not minor pain either. The pain is minor now. I have had a couple of surgeries to improve the problems. Risks go up and up and up.