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VBAC Induction... When should I do it?

post #1 of 16
Thread Starter 
I'm cross posting his in the VBAC section as well but I'm not getting any response, so here goes!

I have kind of a complicated case. I have gestational diabetes that requires a lot of insulin control. I had a ginormous baby last time, was induced and ended up with a c-section due to "fetal distress" and high blood pressure (not pre-e). This time around my OB and I are trying for a VBAC in a town where VBAC friendly docs are rare. He's pretty much "the guy" to see if you want a VBAC. So far, aside from my GD which is well controlled, everything is going in a good direction. I have slightly elevated blood pressure but nothing serious.

My OB really doesn't want me to go past 40 weeks but he will not pressure me either way (we have had some differences and worked them out. He's a good guy) but there is a problem... His daughter is seriously ill and he can only be available for my birth if it happens on a Tuesday!!! He has to travel out of town for her treatment. This is really not a case of him wanting to go golfing. He's really having a tough time and I totally understand. He wants to be at my birth and we both know I have the best chance of VBAC if he's there.

Sooooo.... He wants me to do a balloon catheter induction either at 39 weeks and four days (which he prefers) or 40 weeks and four days (which I prefer, I think). I can go longer as well, but I understand his reasoning as my GD is kind of a wild card. He's also concerned about another ginormous baby. Right now it seems as though this baby is gonna be less than ten lbs at term which I am thrilled about.

I also am working with a midwife and she is going to help me with some other things to encourage labor, such as herbs and homeopathics. Gonna "try" and have some sex as well LOL. Of course, I'd rather go into labor naturally but I know if I do there's a big chance my doc won't be there. But it would be awesome and the best case scenario. My midwife will be my advocate although she can't deliver my baby.

Sooooooo, after all that here is my question for VBAC knowledgeable ladies. If you had to be induced for a VBAC, would you rather have it done during the 39th week or the 40th week? Taking into account my case of GD? I can't really find any statistics and I'm trying to make a decision what to do.

I hope all this makes sense.... TIA!!
post #2 of 16

40 wks.  My "due" dates last baby were 11/24, 11/30, 12/2 AND 12/12.  Depending on the screening or OB on call that day in question.  Much better to make sure baby is fully cooked despite the risks.  I would further recommend, if you go into labor on any other day, stay home until you feel the urge to push, then let DH drive you.  While pushing.  The goal being to have the baby on the moving hospital stretcher while you are on your hands and knees.  That would be my plan.  

post #3 of 16
Thread Starter 
Thank you, Fayebond. I'm not sure how comfortable I am with laboring that much at home. I'm sure it would probably be fine, but I did have some real complications last time and honestly I'm a little scared to not go to the hospital until that point. We'll see. I may feel differently when the moment arrives! I do appreciate your input. My gut is saying wait until 40 wks but there is so much fear involved with the damn GD that I get very confused. I just want to make sure I'm making the right decision...
post #4 of 16

I have had 3 successful VBAC inductions ranging from 38-40 weeks. I would be fine with before 40 weeks if my bishops score was favorable. Otherwise, I would want to give my body/cervix more time to prepare. Inductions only work well when the body is ready. 

post #5 of 16
Dalia I just want to say how sorry I am you are having to consider ok'ing an induction in order to get the doctor you want!.....I read your other thread, and it seems so unfair after how hard you have worked to research and fight to not be induced just bc of your GD or VBAC status! greensad.gif

I was not a VBAC, but I went past 42 weeks with GD, no induction, 10 lb baby, no problems. I completely understand that it seems your best chance is with this OB, it may very well be. But I would tread carefully with induction too; as balloon caths often include Pit, which I believe can increase sections for fetal distress, as well as the (albiet small) chance of uterine scar rupture.

I too would try to wait as long as possible for labor to be more favorable...maybe a Bishops score at the time? Did you go late last time? I guess it depends on how important this doc is to you vs risks of induction.

You are never going to be totally sure you are making the "right" decision...all you can do your best at the time and ultimately it is out of your hands so please give yourself some peace...
post #6 of 16
Thread Starter 
You ladies are wonderful. Getting tears in my eyes! :'-)

Yeah, I'm frustrated with the situation. But I really have no choice at this point. I'm just trying very hard to make the best of it. And I do feel that I most likely will get my VBAC, it's just so damn nerve wracking on the way there!! Sheesh.

I think the idea of going with what my Bishop Score says is awesome. I'm going to tell him that when I see him next week. I think inducing when my body is clearly not ready is basically another trip to the operating table.

I do know that the balloon catheter also often includes pitocin. My doc is a little bit "pitocin happy" as well. I have weighed all my options and feel I might do a little pit of it keeps me from the operating table. I'm willing to take the increased risks.

Earthmama, what induction methods have you used for your VBACs? My midwife is going to give me EPO and some homeopathics, and my doc wants to strip my membranes starting at 37 weeks. If none of that works then he wants to do the balloon catheter. I'm very curious what has worked for others.

Thanks again, y'all. <3
post #7 of 16
I don't know about induction from personal experience, but I think the bishops score is a good starting point.

It seems like waiting until your body is really really close and then going that last bit with induction or augmentation or whatever would be your best bet. I'm just thinking that if you mess with stuff earlier on. . . wouldn't you be more likely to have labor take longer? And then chance going past the Tuesday into a Wednesday? It seems like the only benefit you get from any induction technique is if the baby ends up born on a Tuesday. So if it were me and I knew the GD was managed well, I'd go with a Tuesday when you were almost ready anyway.

If you have a midwife also, wouldn't she be great at monitoring/watching you in early and mid labor so you could get to the hospital later, assuming a non Tuesday? The best place to be is usually where you feel most comfortable, but that scenario of being home is what seems logical and reasonable to me as well.
post #8 of 16
Thread Starter 
I wish I could have my midwife monitor me, but she's acting as a doula in this case and insurance wise/liability wise, it may not be something she is willing to do. She also needs to consider her relationship to this OB. He REALLY wants me monitoring from the get-go. I'm pretty much okay with that... I think... You can see this is all very complicated!

Salr, I just reread your post and I see you mean if the doc isn't in that day. I'm going to ask about that. If both my doc and midwife are on board maybe we can go that route!!
post #9 of 16

My heart goes out to you, I would be so stressed in this kind of situation. One shouldn't have to subjugate one heath benefit (waiting for 40 weeks) for another (being cared for by the right provider). 

 

 

I really don't know about GD complications and the best evidence for early inductions. Is it solely based on concern about baby size, or are there other factors? If it was solely based on size and the GD was well-controlled, I think I would prefer waiting longer over early delivery. I'd ask whether my doctor would consider doing a phone consultation over the phone if anything happened while he was away. Would you have any chance of meeting the other doctors from the hospital? Maybe getting a signed birth plan from your doctor? 

 

And you seem to be talking more about timing that risks of VBAC induction, which is great. But in case it's helpful, here's a discussion of VBAC inductions. Specifically, when they're a GOOD idea: http://vbacfacts.com/2013/02/12/induction-is-wrong-wrong-wrong-wait-what/

post #10 of 16
Thread Starter 
Thank you, RosieL. Surprisingly, I'm not horribly stressed about the whole thing. I have a ton of faith in my midwife, and I think with her support I will pull it off. I also really respect my OB, and if he's there I know we can accomplish something great. There are a lot of unknowns, but I'm just trying to keep my eyes on the prize. It's almost like a challenge. The most important thing to me is not to feel defeated when it's over, no matter what happens. I want to feel empowered and that I had a choice what happened to my body and my baby.

I am considering the risks of induction. I pretty much thinking that inducing before 41 weeks is not the wrong way to go if my cervix is in a good place for it. I have gestational diabetes, but because it is so severe there is sort of a question mark as to whether I am considered to type 2. Because of this, my risks carrying a baby "too long" do go up. So the monitoring at the hospital makes sense to me, as well as my doc's desire to get the baby out a little sooner.

I did read that article you sent and I'm so glad I did. I will definitely choose induction before repeat cesarean if I can. My doc agrees. It would take a lot for me to get on an operating table again. But it might happen and I have to understand that going in.

Keeping my fingers crossed over here. I'll be speaking with my doc on Thursday. I honestly feel so bad for him because his daughter is so ill. He doesn't have as much control as he would like as far as being at my birth. He told me he really wants to be there, but of course his family comes first.
Edited by dalia - 9/17/13 at 3:17pm
post #11 of 16

you can do it! and it is worth fighting for even when (for me it was transition) you don't feel like it.  you go girl!

post #12 of 16
Thread Starter 
Quote:
Originally Posted by fayebond View Post

you can do it! and it is worth fighting for even when (for me it was transition) you don't feel like it.  you go girl!

THANK YOU!!!!
post #13 of 16
I'll be thinking of your through the next week. Labor vibes!


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post #14 of 16
Thread Starter 
Thanks, RosieL! He told me today that he scheduled my induction for the Tuesday AFTER my due date! Yay!
post #15 of 16

I just read this entire thread, and I am so excited for you!  It sounds like you have a wonderful care team!

post #16 of 16
Thread Starter 
Quote:
Originally Posted by MrsRoss View Post

I just read this entire thread, and I am so excited for you!  It sounds like you have a wonderful care team!

Thanks, MrsRose! I'm actually pretty excited to see how it all turns out. I'm feeling very positive. :-)
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