VBACers - Inducing at 38 weeks? - Mothering Forums

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#1 of 41 Old 03-13-2009, 09:33 AM - Thread Starter
 
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I went in for an OB consult a few weeks ago and chatted with her re: my VBAC. She's a great OB and is encouraging patients to NOT have c-sections.... she approached the midwives in our town and wanted to talk with them about reducing our city's high c-sec rate. She is highly knowledgable so I don't get the feeling that the following story has anything to do with her inability to trust a woman's body to go through labour.

Anyhow, she did say that usually with her VBAC clients she suggests doing stretch & sweeps starting at 38 wks so that there is a higher liklihood of a natural vaginal birth success. I was a little surprised by this but she explained that because there are fewer options when it comes to "inducing if necessary" with a VBAC (no oxytocin, for example), that she suggests it.

When I asked my midwives this week at our appointment, they tended to agree as long as mom is on board. She explained that b/c there are fewer options, that their midwifery practice is okay with it too.

Just wondering if other VBACers are experiencing similar suggestions from their midwives/obs?

thanks,
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#2 of 41 Old 03-13-2009, 09:34 AM - Thread Starter
 
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I should say that I'm of the mindset that when the baby is ready to come, the baby is ready to come....I'm not usually for anything to do with trying to induce unless it's medically necessary.

Just wondering if others are hearing the same news.
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#3 of 41 Old 03-13-2009, 10:14 AM
 
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I have no experience with this, but I'd say that if you trust your MW and you feel that she's knowledgeable, I'd go with her advice. From what I hear, a sweep isn't going to make you labor if your body isn't ready to-- it will just give that nudge if your body IS ready to.

In this situation I'd probably do it... although, if you don't want to, you can always say no.

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#4 of 41 Old 03-13-2009, 10:18 AM
 
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The hospital midwife group I saw for my VBAC didn't talk about any kind of labor inducing stuff until you were 40 weeks. Period. Then they started talking sweeps, natural induction methods. Then at 42 weeks, they talked medical induction.

Heather, WAHM to DS (01/04)DD (06/06). Wed to DH(09/97)
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#5 of 41 Old 03-13-2009, 10:58 AM
 
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I went in for an OB consult a few weeks ago and chatted with her re: my VBAC. She's a great OB and is encouraging patients to NOT have c-sections.... she approached the midwives in our town and wanted to talk with them about reducing our city's high c-sec rate. She is highly knowledgable so I don't get the feeling that the following story has anything to do with her inability to trust a woman's body to go through labour.

Anyhow, she did say that usually with her VBAC clients she suggests doing stretch & sweeps starting at 38 wks so that there is a higher liklihood of a natural vaginal birth success. I was a little surprised by this but she explained that because there are fewer options when it comes to "inducing if necessary" with a VBAC (no oxytocin, for example), that she suggests it.
No VBAC here, but AT LEAST she doesn't like using pitocin...I would be very nervous about that and absolutely refuse it since it at least doubles your chance of uterine rupture. Glad you do have an OB who seems to support women's ability to give birth.

I don't see why they can't let things run their course anyway. I haven't seen anything about having a uterine scar leading to your body not knowing how to go into labor.

Alicia, wife to an loving and faithful DH, and mama to three fantastic though nutty children (cs, then an HBAC, then a VBAC!!).
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#6 of 41 Old 03-13-2009, 02:01 PM
 
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No induction here at 38 weeks. VBAC, actually an HBAC here. Getting closer to 40, we'd talk about such things. The baby will come when she's really ready. :-)
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#7 of 41 Old 03-13-2009, 02:06 PM
 
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Here's a great Midwifery Today article that might answer some questions. It does seem to agree with the whole "no pitocin" argument, but I'm not sure about stretching and sweeping.

http://www.midwiferytoday.com/articl...erCesarean.asp

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#8 of 41 Old 03-13-2009, 04:41 PM
 
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VBAC'er here

I'm not entertaining the idea of any type of induction until at least 41+ weeks without good cause. My midwives are on board for leaving well enough alone, they don't use medical induction for VBAC at all. They are willing to try a Foley catheter induction if it got to that point, though I would be their first one.

38 weeks is still early and I wouldn't start anything induction-wise at that time if I didn't have clear signs of impending labor.

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#9 of 41 Old 03-13-2009, 05:07 PM
 
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VBAC'er here

I'm not entertaining the idea of any type of induction until at least 41+ weeks without good cause. My midwives are on board for leaving well enough alone, they don't use medical induction for VBAC at all. They are willing to try a Foley catheter induction if it got to that point, though I would be their first one.

38 weeks is still early and I wouldn't start anything induction-wise at that time if I didn't have clear signs of impending labor.
What's a foley catheter?

Alicia, wife to an loving and faithful DH, and mama to three fantastic though nutty children (cs, then an HBAC, then a VBAC!!).
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#10 of 41 Old 03-13-2009, 05:11 PM
 
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Incuction at all is not a great idea. Sweeping the membranes can lead to monitoring, waters rupturing,and baby being forced into a unfavorable possition it the waters do break. There is no reason for anyone to put their fingers up you at any point until the later part of labour. Stand your ground now and then your provider will hopefully stop trying to manage or rush a natural labour. Trust the body to know when it is ready.

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#11 of 41 Old 03-13-2009, 05:19 PM
 
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Yeah, I was thinking about the change in intimacy -- my midwives have never given me any kind of physical exam. They'll get to know me pretty well when the baby's coming!
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#12 of 41 Old 03-13-2009, 05:27 PM
 
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Yeah, mine are very laid back about timing. At one of my appts they brought up that they had a mama who was on day 17 after due date and they were just patiently waiting!! They also do not do anything invasive including exams. They aren't even in favor of exams during labor. They think that external observation is a better indicator of how far along you are than dilation.

But, chai I'm remembering that you are birthing in a hospital setting correct? If they are being bound by the rules of the hospital it sounds like a much better idea to stretch and sweep than to wait till the end of their timetable and then have to induce with pit.

My midwives have no licensing so they have their own policies and aren't bound by regulations.

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#13 of 41 Old 03-13-2009, 05:56 PM
 
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my midwife told me they do not induce (other than naturally) because of the increased risk of uterine rupture. i didn't ask more because i don't want to be induced... i'd rather have a "late" c-section than another undercooked baby *sigh.
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#14 of 41 Old 03-14-2009, 12:09 AM
 
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One VBAC done, planning on another.

The OB practice I'm using and the MWs I met with both say NO induction... period.... none. Everything I've read says none. Personally I would only if I was 42 weeks and had medical reason, like it was c/s or induction, then I would favor induction by whatever means starting at less of course and working my way up. If they are pressuring you because they are giving you a 40 week timeline, refuse. There was one OB at the hospital that told me if I didn't consent to pitocin (this was after my water broke, but before labor really started) that I was going to have another c/s, I told him to shove it

Something to remember is no matter what form of induction they use if that baby is not telling your body in anyway to open then it will not come out vaginally.

Cook, my understanding is its a catheter they insert and it has a balloon they expand on the end of it..... I think..... I could be wrong......

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#15 of 41 Old 03-14-2009, 12:36 AM
 
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What's a foley catheter?
Its a type of catheter, with a balloon attached. They insert it and inflate it, using it to stretch the cervix in the hopes that it will trigger labor without the need for any medications. It usually falls out on its own once you reach 4 cm and is the least risky of the induction methods out there. But you have to already be at least 1 cm (I think) to even insert it.

Its a last resort for me if I don't go into labor on my own by 41+ weeks, since I'm birthing in the hospital. I don't see myself going that long though, I went into labor on my own with DD at 40w3d.

Of course, circumstances could change. If I'm having never ending labor that isn't really kicking into gear, I would try a membrane sweep.

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#16 of 41 Old 03-14-2009, 03:38 AM
 
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Speaking as a doula, I would say that messing with the process at all for a VBAC mom is a bad idea! Every intervention is one step closer to the biggest intervention of them all. I would avoid anything until 41+ weeks.
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#17 of 41 Old 03-14-2009, 06:44 PM
 
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I'd love to say, let baby take her own sweet time. But in my situation, I'm moving two weeks after she is DUE to Wisconsin from Florida. My midwife at my OB practice suggested checking my cervix at 38 weeks. If it seems soft, we'll do a membrane strip. Certainly not my ideal way of bringing this on, but the mandatory section at 41 weeks I'd have to have JUST ISN'T GOING TO HAPPEN. Not less than two weeks before I have to move across the country. So, I say, whatever you need to get your vaginal birth. My doctor won't use drugs to induce at all, but I'm interested to see if stripping works. It's better than just scheduling another section, IMO. Good luck to all the other VBAC'ers.

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#18 of 41 Old 03-14-2009, 07:46 PM
 
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I am going to move this to our VBAC forum.

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#19 of 41 Old 03-14-2009, 08:25 PM
 
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We did talk about trying a foley induction with both of my last midwives but that would have taken place between 42 and 43 weeks (we would have had to find an OB willing to do it so it might have been near the end of 41 weeks if that was when they were in but not any sooner).

I had my two vbacs at 41 weeks and 40 weeks and 6 days respectively. My failed induction/c-section took place at 42 weeks and 2 days so obviously I carry my babies longer than 40 weeks normally so an induction for me at 38 weeks probably wouldn't have worked or if it did resulted in a baby with preemie like symptoms. I wouldn't do it that early at all.

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#20 of 41 Old 03-15-2009, 02:01 AM
 
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Hi

I'm in your DDC and am going for a HBA2C. I have a very experienced midwife and she is against induction of any type. She views all of them as unnatural and possibly detrimental to the very personal rythm and timing each woman has. It is your body and your choice, they can't actually make you try and induce. I would say that as long as you and the baby are doing well then there is no reason to make the baby come sooner than he/she is ready.

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#21 of 41 Old 03-15-2009, 12:15 PM
 
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The OB practice I'm using and the MWs I met with both say NO induction... period.... none. Everything I've read says none.
That is odd, because even ACOG is ok with pitocin to induce a vbac.

I personally would not choose a repeat c-section over induction. I wouldn't consider induction until 41+ weeks, but I'm comfortable with the slightly increased risk of using pitocin.

I would never agree to a prostaglandin induction with a VBAC however, as it has been shown to have UR rates in the 2-3% range.

I am against stretch & sweeps until induction talk begins (again which I wouldn't entertain until 41+ weeks unless there was some pressing medical reason) because there is a risk of infection/ROM any time fingers are up there.

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I'm comfortable with the slightly increased risk of using pitocin.

I would never agree to a prostaglandin induction with a VBAC however, as it has been shown to have UR rates in the 2-3% range.
From what I have read, that is the rate for pitocin as well.

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#23 of 41 Old 03-15-2009, 09:02 PM
 
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From what I have read, that is the rate for pitocin as well.
it's not. it's around 1%

http://www.homebirth.org.uk/vbacinduction.htm - that link has a bunch of studies and a chart at the bottom.

from the 2004 ACOG practice bulletin on vbacs:

Quote:
In one large retrospective study of more than
20,000 women, uterine rupture was nearly 5 times more
common among women undergoing labor induction with
oxytocin compared with those who had an elective repeat
cesarean delivery (37). However, uterine rupture occurred
in less than 1% of women in both groups. Furthermore,
among the women attempting VBAC, the rate of uterine
rupture was not different between those who received
oxytocin and those who labored spontaneously.

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Well, I had the membranes swept at 39 weeks and developed a horrible infection from it, which gave me a 104-degree fever, which my daughter also got, and started "labor" that wasn't real, natural labor and I had to be hooked up to Pitocin because the contractions weren't strong, active ones but I already had an infection. It sucked. I don't recommend it.

Also, know that there's a risk of rupture your water by doing this procedure, and then you're kinda screwed into Pit (even VBACing) or a repeat when it turns out you were too early for the baby to come on it's own.

My advice is just to wait. If you get to 41 weeks, MAYBE consider it then.

By the way, ACOG is a scam that is the key player in destroying birth in America. Don't take ANY advice from them!!!!!

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#25 of 41 Old 03-15-2009, 09:58 PM
 
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By the way, ACOG is a scam that is the key player in destroying birth in America. Don't take ANY advice from them!!!!!
possibly, but they are also VERY conservative when it comes to recommendations/limitations in VBAC. They even list vba2c as a contraindication to vbac (which it is totally not!) but are fine with pitocin.

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#26 of 41 Old 03-15-2009, 10:11 PM
 
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possibly, but they are also VERY conservative when it comes to recommendations/limitations in VBAC. They even list vba2c as a contraindication to vbac (which it is totally not!) but are fine with pitocin.
I'm reading the book "Pushed" by Jennifer Block right now, which I recommend because it's pretty much the history of American birth and how it got to the messed-up way that it is. And ACOG has always been the ones making the horrible calls that cause all the problems. Pitocin isn't only bad for first-time moms, it's bad for ALL moms! It shouldn't even exist... it's way too potent and only causes problems, like hyperstimulation of the uterus, which can kill a baby in no time at all and leads to so many of those freakish maternal death stories you hear about. ACOG is not a good place to get information, as it is on par with getting vaccine information from the CDC! Just another government mouthpiece doing what makes the most money for the most people. Pit does increase risk of rupture, by 5 times in a VBAC situation. I don't care what ACOG says, all the other studies say 5 times increased risk.

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I have read Pushed. I have also read many other studies on pitocin and vbac (and posted some of them above). Even voracious natural birth advocates recognize the use of pitocin in certain labors as beneficial.

If you want an interesting perspective on how some totally natural labors went before the advent of current day medicine, a great book to read is Birth: The Surprising History of How We Are Born by Tina Cassidy. The birth climate now is far from ideal, yet I would be very leary to go back to the days when a stalled labor meant a dead baby that they used some pretty awful tricks to remove from the mother. Or terrible fistulas (still actually common in some parts of Africa where they don't have access to medical care).

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#28 of 41 Old 03-15-2009, 10:36 PM
 
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No doubt the history of birth is rocky. But once we learned about hygiene and how to keep things clean, birth outcomes improved drastically! I have no doubt that the improvement of birth from the olden days when babies died and had to be crushed and removed with forceps (their lovely original purpose) is due solely to hygiene and NOT to pitocin! Pitocin causes unnatural contractions that your body isn't prepared to handle. And it can't cross the blood-brain barrier, so the effect of natural oxytocin on the brain, being the love / bonding hormone is completely absent.

I hear stories of women who give birth and are crying and happy and instantly in love with their children. And then I look back at my births - one which was induced with Pitocin for 21 hours before being put under general anesthesia for 10 hours while they removed my daughter, and one which there were no drugs except a spinal, and I didn't cry, I wasn't happy, I wasn't in love with my babies. I am such an emotional person, but I didn't get to really experience birth because I was hooked up to some synthetic drug that was supposed to replace and be just as good as my natural oxytocin. What a joke! I seriously don't know how anyone can be in support of Pitocin when you think about the emotional toll on babies and mothers from using it, not to mention the studies that show the increased risk of rupture from it.

There's also a suggested connection between the use of Pitocin during birth and autism, among other later-manifesting problems.

Bottom line is, it's not worth it. You sacrifice all the emotion of your child's birth, while increasing your chance of problems. There is solid evidence that a first-time mother using Pitocin has an increased risk of a c-section by 3 times! 3 TIMES! And just adding the epidural to that takes the risk up another huge step. If only I had known then what I know now about Pit and epidurals....

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#29 of 41 Old 03-15-2009, 10:42 PM
 
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I'd love to say, let baby take her own sweet time. But in my situation, I'm moving two weeks after she is DUE to Wisconsin from Florida. My midwife at my OB practice suggested checking my cervix at 38 weeks. If it seems soft, we'll do a membrane strip. Certainly not my ideal way of bringing this on, but the mandatory section at 41 weeks I'd have to have JUST ISN'T GOING TO HAPPEN. Not less than two weeks before I have to move across the country. So, I say, whatever you need to get your vaginal birth. My doctor won't use drugs to induce at all, but I'm interested to see if stripping works. It's better than just scheduling another section, IMO. Good luck to all the other VBAC'ers.
You don't have to consent even if you go past 41 weeks. They cannot force you to do anything you just have to have the will to carry on through the drama that goes with saying no. Keep in mind if you are highly stressed about moving, there is a good possibility your body will clamp down and you could easily go past DD.

Thorn - that is not what ACOG said a couple years ago + I agree with PP I don't put too much stock in what is said by them these days anyway, its amazing what 2 years can change! I suppose I am now a conspiracy theorist.... Thank you MDC

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#30 of 41 Old 03-15-2009, 11:51 PM
 
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Originally Posted by writteninkursive View Post
I have no doubt that the improvement of birth from the olden days when babies died and had to be crushed and removed with forceps (their lovely original purpose) is due solely to hygiene and NOT to pitocin!
explain to me how good hygiene would prevent an entrapped baby?

Quote:
There's also a suggested connection between the use of Pitocin during birth and autism, among other later-manifesting problems.
I have an autistic daughter. And no, I didn't have any pitocin in her non-labor.

Quote:
There is solid evidence that a first-time mother using Pitocin has an increased risk of a c-section by 3 times! 3 TIMES!
There is solid evidence that induction increases the risk of a c-section in a first time mother - not "use of pitocin" - induction. I am aware of the stats. That doesn't change the fact that sometimes induction is medically necessary. It doesn't make pitocin evil. Is it overused? Definitely. Are women induced for no better reason than the OB's vacation schedule? Absolutely.

But are there cases where the baby NEEDS to come out and the options are immediate c-section or pitocin? Yes. And if I were in that position, having had both a c-section and vaginal birth, and being fully aware of the risks of inducing a vbac *I* would still choose that over going straight to a c-section.

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Thorn - that is not what ACOG said a couple years ago
that quote that I posted is taken directly from their 2004 Practice Bulletin on VBAC. I'm not saying that ACOG is some great organization - I'm not sure where anyone got that idea. I am saying that *even* ACOG who wants to limit vbacs as much as possible still doesn't say that pitocin is totally un-useable in a vbac.

Christine, mom to C(7.5) - E(5) - J(3) - B(10 mos)

Doula, childbirth educator, Co-leader of ICAN of Atlanta

 

"Never miss an opportunity to make others happy, even if you have to leave them alone in order to do it." ~Anonymous

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