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Safety of induction for VBAC?

post #1 of 4
Thread Starter 

I'm not certain yet, but I may have the choice of a repeat c-section or induction at 38 weeks due to an IUGR baby.  So far baby is doing okay (she may just be constitutionally small since I'm 5'1'' although hubby is average height), and if she continues to do well I won't have to make the decision until 41 weeks.  However, I am getting a growth ultrasound at 38 weeks which may show differently.  From what I understand induction will give me a 3% risk of rupture, vs. about 0.5% if I go into labor naturally.  What would you do?  I would never forgive myself if I iatrogenically gave myself a rupture.  Plus Pitocin really scares me.  Yet I don't want to have surgery unless it's necessary.

 

Thanks for any advice you have!

post #2 of 4

You sound like you don't want an induction.  And your provider sounds like they aren't open to your choices outside of a narrow paragdim.  It may be a good idea to look around for a provider who is willing to listen to you, and forgo the 38 week ultrasound.  Or can you ask them to move your due date back a week so that your baby isn't at risk for being too early?  You do have the option of simply not showing up after 37 weeks, basicall until transition, but I would not recommend that unless you really have no other VBAC options. Find someone else to pay to advise you.

 

Inductions do up your risk of rupture, and inductions even in an unscarred mama often lead to a CS.  Its not practical to expect a woman to come in and perform labor on demand, especially a full two weeks before your estimated due date.  

 

That said, there are reasons to do an induction that are valid.  With my last baby (successful unassisted VBAC), I had labor for four hours.  Twice.  Moved a couple centimeters each time but mostly it was just two weekends of getting very tired and then waiting.  Baby got to a plus one station (her head was entirely into, and even partly out of, my pelvis) for the entire three weeks.  Then finally we had the labor that progressed into actual pushing, but the midwife didn't make it in time.  I was on the bathroom floor and paniced and wet and cold and just generally it was an empowering but lets-not-repeat-that-if-we-can-type experience.  So this baby, we are considering a natural induction sometime when my body is ready, in a calm room with labor going with midwife there  I'm very comfortable with this (potential) induction plan.  

 

But your plan above, I would not sign up for.  I'd ask for other options, another provider, find a midwife, not go in after 37 weeks, anything.  I'd be too nervous about not performing fast enough and the baby not being cooked enough and would they turn off the pitocin when I asked and would all the cervical checks after my waters broke lead to infection and, oy, the list is too long.  Too much stress for me!  I'm sure you will find the right solution for you mama.

post #3 of 4

Induction on a VBAC at early term? I'd lean against. Induction may not even be on the table. Almost no OBs, certainly in the US, will risk prostaglandins. You're limited to Foley and pit at best. If you're not in a condition for either of those to work, and baby needs to come out, your only option is CS. And, honestly, I would not take a significantly increased risk of rupture over the risks of a CS. THe risk benefit isn't there, which is why OBs don't do it. 


I do not believe the benefits of more time come into play if baby is IUGR, and I would not play around with that and decline u/s. IUGR is the result of a placenta that is not fully functioning. Baby is better off on the outside than on the inside with a placenta that is failing. Is your provider performing doppler blood scans with the u/s to detect blood flow to the baby? 

post #4 of 4

I looked into this recently because I live in a new area and the OBs and MWs here are a lot more conservative with their use of pitocin and vbacs and I even had to change practices because an OB told me she would flat out not use it on me and schedule a c/s if I went past dates - this after I have had THREE successfully pit induced VBA2Cs! Not ok.

 

The risks of rupture go up with Pitocin but not as significantly as the medical profession would lead you to believe. Its still less than 1%. They say the risk is nearly double - what that equates to is going from .4 without pitocin to .7 with pitocin. That is not significant enough for me to consent to a repeat C/S which in my mind is not without significant risks of its own.

 

I had an induction at 38 weeks with my first vaginal birth (3rd baby) and it went very well. My cervix was around 1.5-2cm and 50% effaced so I am sure that helped. My 2nd VBA2C was at 39wks 4 days and my 3rd was at 39 weeks. I am 40 weeks tomorrow and hoping to avoid induction but I will gladly use pitocin if it comes down to it. 

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