Pitocin & VBAC - Mothering Forums

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#1 of 26 Old 01-08-2010, 04:26 PM - Thread Starter
 
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Okay I've been mostly reading on various different sites that you should NEVER use pitocin for a vbac - could create complications. Then I just talked to someone that said that it may be helpful in the very end if you are progressing but just need that extra little "kick".

I want to have a VBAC, but I don't want to be induced. I strongly believe that's why I had a c-section with my DS. I am okay with waiting till 41 or 42 weeks (however long my provider will go)...to let my DD come when she is ready...if she doesn't...I'm okay with a c-section knowing I held out for a vbac. Hope that makes sense. I just want to be the least intrusive/un-natural as possible.

Any thoughts??
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#2 of 26 Old 01-08-2010, 04:58 PM
 
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#3 of 26 Old 01-08-2010, 05:08 PM
 
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You can use Pitocin on VBAC, but at a lower dose and it is better to use to augment labor than start it, but, the less you do, the better your chances of having a VBAC. Go into labor on your own, let your water break on its own and avoid pain meds for the best chance, but many people have had successful VBACs with induction and pain meds.
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#4 of 26 Old 01-09-2010, 12:36 AM
 
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Okay, so I actually talked to my dr. about this today. I was saying how I prefer not to be induced (he was talking about it b/c I live 2 hours from the hospital and said he'd rather me be induced than risk a rupture while trying to drive there). He said he would do whatever I want, but that there have been studies that show your best chance at a successful vbac is if you have the baby at 39 weeks, and then it drops a little as you get to 40 weeks and it drops off substantially by 41-42 weeks. He said it's because of the size of the babies and the placenta degrading. Now, I haven't actually seen the studies, this is just what I was told today.
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#5 of 26 Old 01-09-2010, 12:47 AM
 
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Okay, so I actually talked to my dr. about this today. I was saying how I prefer not to be induced (he was talking about it b/c I live 2 hours from the hospital and said he'd rather me be induced than risk a rupture while trying to drive there). He said he would do whatever I want, but that there have been studies that show your best chance at a successful vbac is if you have the baby at 39 weeks, and then it drops a little as you get to 40 weeks and it drops off substantially by 41-42 weeks. He said it's because of the size of the babies and the placenta degrading. Now, I haven't actually seen the studies, this is just what I was told today.
That's because by the time 40 weeks hit, so many docs start the push for a RCS. Personally, I wouldn't trust that study w/o seeing it and it's specifics. I don't buy it.

To the OP...how far do *you* feel comfortable going? A provider doesn't have a choice but to go as far as the Mama will allow.

- Kim
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#6 of 26 Old 01-09-2010, 12:49 AM
 
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I don't think you'll have a successful VBAC when your body just isn't ready at 39 weeks. What's the purpose to have your waters broken at 39 weeks when your cervix is long and hard?

I didn't want to be induced with DD because I wanted to VBAC and I felt like all the interventions during DS birth lead to him being OP and just in a weird position. I was 40+3 when I was induced (for hypertension) but my cervix was just 1cm and 25% so basically we weren't ready at all.

With DD however, I still didn't go into labor, I was induced again. First attempt was at 40+3 (OB didn't want me to go past the 40 week mark) but she was too high and he couldn't break the water because he was scared of a possible cord prolapse. Cervix was at 4cm and 25%. Then I went back for induction at 40+5 and my cervix magically softened to 80% and dilated to 6cm. Mind you, I still wasn't in labor..not one contraction except braxton hicks. I did get a low dose of pitocin to get me going and I also had one on one care with only one nurse. My OB broke my water and babygirl was born two hours later.

Good luck to you mama. HOpe you get your VBAC.

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#7 of 26 Old 01-09-2010, 11:18 AM
 
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#8 of 26 Old 01-09-2010, 02:04 PM
 
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It is your decision. IMO, reasonable either way.
Me, I'm comfortable with low dose pit and have had multiple inductions that way now along with one full pit induction (1994) and cervidil induction (1996) before the current guidelines were in effect.
One of my criteria for OB/CNM is one who will induce VBAC's as it is often what I need now (PIH/PE). Thankfully, I have been able to find them. If my OB didn't believe in gentle VBAC inductions (and I was a grand multip with a ripe cervix) my last two would have been C-sections.

Karen, homeschooling Catholic mom to 8. #9 due 6/10
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#9 of 26 Old 01-09-2010, 05:14 PM
 
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I went into this pregnancy saying that I would never be induced again, no matter what. But as I come to terms with some of the ways that I am high risk, I have realized that there is a possibility I may have to consider it at some point, so I am trying to be as educated about it as possible. My provider does not induce without a clear medical indication. "You're past 40 weeks" is not a clear medical indication. Neither is "your fluid looks a little low" or "your blood pressure is creeping up" and some of the other reasons that OBs sometimes give. I know my OB well enough to know he doesn't induce for those reasons, though. (He is a member of my local ICAN group and has done hundreds of births for our group over the past few years.)

Pitocin is not contraindicated for a VBAC. In fact I believe even ACOG's guidelines say that pitocin okay, and a lot of what ACOG says is overly risk-averse and conservative. Is pitocin my idea of a good time? No. Last time it was torture. I wanted to die. BUT I have come to learn that not all pitocin inductions are created equal. My last one, the doctors pretty much cranked it up as high as it can go and as fast as it can go and left me alone to suffer. There is a such thing as a "low and slow" induction, and a good provider will even back off on it/turn off the pitocin if the labor is progressing. I'm still not recommending it, but all of the best hospital providers I know of (and they are a rare breed) have used pitocin judiciously at some point. For the record, prostoglandins (cervidil/cytotec) are contraindicated for a VBAC so you should never use those. Someone mentioned the foley bulb method of induction and that is a good one, too. Here's some info on pitocin induction and VBAC.

What it boils down to is for me I'd rather go through an induction again with a trusted provider than have another c/s.

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Originally Posted by kellij View Post
Okay, so I actually talked to my dr. about this today. I was saying how I prefer not to be induced (he was talking about it b/c I live 2 hours from the hospital and said he'd rather me be induced than risk a rupture while trying to drive there). He said he would do whatever I want, but that there have been studies that show your best chance at a successful vbac is if you have the baby at 39 weeks, and then it drops a little as you get to 40 weeks and it drops off substantially by 41-42 weeks. He said it's because of the size of the babies and the placenta degrading. Now, I haven't actually seen the studies, this is just what I was told today.
?? I don't know if I buy what your doctor is saying. For one thing, uterine rupture can happen any time, not just during active labor. It can happen any time during pregnancy, it can happen during a c/s, it can even happen after the baby is born, although that's really rare. Anyway, if you have to be in the hospital to mitigate a slight chance of UR then I'd think you would just have to start living there at some point, and that doesn't make any sense! I believe that I have read something about that study about the 39 week thing, but actually your chance of a successful VBAC is higher if you go into labor on your own whether it be 39 weeks, 40 weeks, 41 weeks, whatever. So yes you have a slightly better chance at 39 weeks, but you have a much better chance if you are not induced even if it is a later gestational age! Also, what does placental degradation have to do with VBAC?! That's a pretty rare phenomenon but the chances of that happening the later you go in pregnancy are for any pregnant woman. I don't think there is any increased chance of that as a VBAC. And the chances are so small it does not indicate inducing for that reason alone.

This may be what your OB is referring to about VBAC and "big baby," but it sounds like he got it wrong. This is ACOG's 2004 recommendations on macrosomia and VBAC:

Quote:
Macrosomia
Although macrosomia (usually birth weight greater than 4,000 g or 4,500 g, regardless of gestational age) is associated with a lower likelihood of successful VBAC (28–31), 60–90% of women attempting a trial of labor who give birth to infants with macrosomia are successful (30, 31). The rate of uterine rupture appears to be increased only in those women without a previous vaginal delivery (31).

However, multiple cesarean deliveries also carry maternal risks, including an increased risk of placenta
previa and accreta (67, 68). Based on these risks, one decision model analysis found it is reasonable to consider a trial of labor if the chance of success is 50% or greater, and the desire for future pregnancy after cesarean delivery is at least 10–20% (67).
A friend of mine compiled a bunch of info about this and here is what she says (just so I don't take credit for her work):

Quote:
So even though a big baby may decrease the statistical rate of VBAC success when compared to a smaller baby, 60-90% of attempts are still successful. Frankly, with our national C/S rate hoovering about 1 in 3, even this "lower success rate" sounds pretty normal. And note that even with the "lower rate," according to these recommendations given later in that publication, it is still "reasonable to consider a trial of labor" (especially if the mother is considering at least one more pregnancy after the current one - but not only then).

Blair, mom to the amazing Nora (8/06) ribboncesarean.gif, sweet Anneliese (2/10) vbac.gif, and super Henry (8/12) vbac.gif

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#10 of 26 Old 01-09-2010, 06:38 PM
 
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I should also say that the dr. says that he would only induce if your cervix is ready to go and he mentioned something about being dilated to a 3 (I don't this it HAS to be a three, but the point is that you're are dialating.) I think he also does the low and slow pitocin. I think the point is that it could be a balancing game to some extent. If your body is dilating naturally and your cervix is otherwise favorable, then I think he's saying the benefits of induction at 40 weeks with a favorable cervix might outweigh the risks of not inducing and waiting 2 more weeks. I also have big babies, so while I know it's fine with big babies, I would imagine it's more challanging with a 10.5 lber!

I actually have a call into another dr. to see what he says. I know he won't induce ever, etc. I feel a little better about that stance, but his nurse didn't think he'd take me because she thinks he requires at least one vaginal birth in there.

So I'm just going to hope I go into labor on my own before 40 weeks and I'm going to do everything I can to make that happen naturally. Then I'm following the wait and see approach after 40 weeks. Oh, I'm also going to see about if I have to use pitocin to get things started if they start if we can stop the pitocin.
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#11 of 26 Old 01-09-2010, 08:45 PM
 
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I had pitocin with my VBAC. After about 20 hours of labor I was getting worn out and my contractions started to be all over the place. The doctor started with a very low dose of pit and gradually increased it to help my contractions.

Cat (30) DH (30) Carissa Grace born 11/3/07 via c/s after fetal distress. Sophia Claire born 10/9/09 VBAC!
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#12 of 26 Old 01-09-2010, 11:19 PM
 
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I believe there was a study showing a lower likelihood of success with a VBAC after 41 weeks (NOT 39) but I don't have the citation and IIRC they weren't sure why it happened.

I would be fine with pit to augment (if augmentation were really called for--but I wouldn't change my mind because of the scar) and I would consider a careful pit induction if an induction were medically necessary. I have high blood pressure and a history of severe PE, so it's something I have to think about.

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#13 of 26 Old 01-10-2010, 12:43 AM - Thread Starter
 
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Well thanks everyone! There are several great opinions and personal experiences in here. After a little further research and reading these posts I'm still not 100% on a stance but I do feel that regardless EVERY woman is different. So I know that some have posted on here that they needed a little pit and it worked for their successful VBAC...that's awesome! I also think that with other women it could hinder them. It's just so subjective ... it's really a hard thing to have a specific stance on. Totally case-by-case in my opinion...again I have a lot more reading and learning to do...but that's where I'm personally at right now.

I'm willing to go to 42 weeks NOT because of hearing that VBACS can be unsuccessful BUT because of the environment deteriorating at that point and the possible effects on the baby. I'm going to probably hit an acupuncturist really heavily and HOPE that works!
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#14 of 26 Old 01-12-2010, 05:07 PM
 
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Macrosomia-Ok, first off, true macrosomia RARELY happens. Once you hit 39 wks or so, be very conscious of what you eat of course as ever, but I was under the impression of studies that baby's weight begins to plateau at around 40 weeks, so I wouldn't worry about a baby getting dramatically bigger in the last 3 weeks, that being if you get to 42 weeks.

placenta aging-this is an old card OBs pull to get you to induce. I am a firm believer in that. You body has a placental/fetal clock, and the baby and placenta give off CRH hormone and THEY tell your body when labor should start. Also, the later you wait the more relaxin your body produces for your joints so you pelvis is more helpful in labor.

Pit and VBAC-In what I have seen, induction/augmentation ups the odds of uterine rupture from around .5% to above 3% in some studies. So, your Dr. worrying about you rupturing Out of hospital is unnecessary worry, the worry of you ruputuring in hospital with induction/augmentation is quite necessary concern http://childbirthconnection.com/arti...7#artificially my interpretation of this article says there is a risk. I think the reason ACOG says it's ok, is it's almost like an addiction to DR an hospitals to use Pit, so saying, "don't do it for VBAC" would mean a lot less VBACs in hospitals. Also, it gives another reason to VBAC in hospital, "you can induce!"

41-42 week induction-it's not about how far your provider will go. It's about how far you have decided is safest for your situation and your baby. Every organization (including ACOG) says that up to 42 weeks pregnancy is considered term, and it is NORMAL for a pregnancy to go this long. It isn't typical, as moms usually go into labor before that either on their own or by induction, but it is NORMAL and HEALTHY to go into labor at 42 weeks.
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#15 of 26 Old 01-12-2010, 05:22 PM
 
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Pit and VBAC-In what I have seen, induction/augmentation ups the odds of uterine rupture from around .5% to above 3% in some studies. So, your Dr. worrying about you rupturing Out of hospital is unnecessary worry, the worry of you ruputuring in hospital with induction/augmentation is quite necessary concern http://childbirthconnection.com/arti...7#artificially my interpretation of this article says there is a risk.
Just so you know (since I was the first person to bring up the CC link) I am with you on there being a risk with pitocin--I would definitely tell any VBAC mom to avoid it at all costs if possible. But the other side of the coin is that I'm glad it's available for use in VBACs in a situation where an induction might be medically indicated. Rare, yes. But I hate hearing stories like "I was planning a VBAC and I developed pre-e so I had to go straight to a repeat c-section since my doctor wouldn't use pitocin."

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I think the reason ACOG says it's ok, is it's almost like an addiction to DR an hospitals to use Pit, so saying, "don't do it for VBAC" would mean a lot less VBACs in hospitals. Also, it gives another reason to VBAC in hospital, "you can induce!"
Maybe, although I'm not convinced that ACOG cares whether VBAC happens at all. I get the feeling that it would be just as well with them if no one had a VBAC, hence the huge number of de facto (and totally bogus) VBAC bans.

Blair, mom to the amazing Nora (8/06) ribboncesarean.gif, sweet Anneliese (2/10) vbac.gif, and super Henry (8/12) vbac.gif

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#16 of 26 Old 01-12-2010, 08:43 PM
 
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Maybe, although I'm not convinced that ACOG cares whether VBAC happens at all. I get the feeling that it would be just as well with them if no one had a VBAC, hence the huge number of de facto (and totally bogus) VBAC bans.
Yeah, I can definitely see them not caring. I think that the majority of women who want a VBAC and feel strongly about it do birth at home, and since they are very against HB in any instance, I can see them deeming it only "suitable" to VBAC in hospital.

And for the induction for pre-e, yeah I AGREE, if it were me in that situation, I would ABSOLUTELY opt for induction over cs. Of course I would try midwifery type options to bring down BP and edema and protein, etc, and if those proved unsuccessful, then I would go induction.
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#17 of 26 Old 01-13-2010, 12:24 AM
 
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You know how drugs are given a "pregnancy category", A, B, C, D and X, with A being safe and X being absolutely contraindicated (e.g. thalidomide).

I personally would say that none of the drugs used in induction for VBAC fall into the X category, though cytotec comes close, but with other cervical ripening agents being a D as well. Pitocin I'd actually give a C to. Of course all this assumes correct use, but then so does the categorisation for any other drug.

Like others I'm frustrated with the prior c-section, complication force repeat c-section thing. If the complication is definitely a must deliver situation and you can't even insert a foley, then I don't think the risk of a low dose of a prostaglandin in a removeable form (i.e. not the gel) is enough to label it absolutely contraindicated - though I think it would be reasonable for a doctor not to just offer and say that's what we do next, more like not outright refusing when a woman asks if there are other options.

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#18 of 26 Old 01-13-2010, 12:33 AM
 
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Okay, so I actually talked to my dr. about this today. I was saying how I prefer not to be induced (he was talking about it b/c I live 2 hours from the hospital and said he'd rather me be induced than risk a rupture while trying to drive there). He said he would do whatever I want, but that there have been studies that show your best chance at a successful vbac is if you have the baby at 39 weeks, and then it drops a little as you get to 40 weeks and it drops off substantially by 41-42 weeks. He said it's because of the size of the babies and the placenta degrading. Now, I haven't actually seen the studies, this is just what I was told today.
Nearly every provider in my city who claims to be VBAC friendly does it with the conditions - you must go into labor on your own by 39 weeks. It is not that the moms are less capable of VBACing after that - it's that the providers are less willing to let a labor run its course with any confidence in a normal outcome. More intervention - more doubt - more c-sections. Also, for doctors who are willing to induce VBACs, they are more likely to push for induction after 40 weeks, and we all know inductions lead to more c-sections.


I personally would take some pit in a moderate dose rather than go automatically to Cesarean. I think it is a risk every mom has to carefully consider and make a decision on. I know so many women who have had successful VBACs with Pit involved - I think now that doctors know the risks of it there is so much more restraint in its use. That said, I would still prefer to go into labor and let it progress naturally - pit more as a last resort.

JMHO

I'm Kellie :, married to Chris , and mom to one baby girl (7/12/09).
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#19 of 26 Old 01-13-2010, 03:10 AM
 
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I'm still trying to find a dr. that will take me that will be less interventionist. However, if this is the only guy that will take me, I'm just going to hope for the best and do all I can to try to do things the way that will hopefully have the best outcome for my baby and me. I think he'll let me go past 40 weeks, if necessary, he's just saying he doesn't think odds are as good. I figure I'll just decide at the time based on how my cervix is looking, etc. I'm crossing my fingers that I'll go into labor before then and it won't be an issue!!

Today I talked to a midwife at another location and she said the drs at her hospital will do the vbac if you refuse a c-section, but if you stall for a long time and pitocin would help you continue on, they won't give it to you and you get a c-section as a result. So at least this dr. would clearly give it in that situation.
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#20 of 26 Old 01-13-2010, 03:23 AM
 
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I feel a Doula is necessary in almost EVERY hospital birth. The only ones I say you could get away with not having one, is if your partner happens to be a Doula.

If you are at all worried about a Dr. who is intervention happy, or a hospital that is reputable for their high cs rate and low vbac rate, have a Doula. They will help you AND your partner think clearly , speak for yourself, help you cope with pain, and speed your labor without Pit. Here are just some stats of Doulas when studied.

Research shows that the presence of a doula can lead to a:
60% decrease in use of epidurals
50% decrease in cesarean sections
40% decrease in use of pitocin
30% decrease in use of pain medications (narcotics)
30% decrease in use of forceps
In addition, long-term benefits of labor support include:
Improved breastfeeding
Decreased postpartum depression
Greater maternal satisfaction
Better mother-infant interaction

Especially being a VBAC, I would think you could benefit from ALL the support you can get. If you don't have the money or one, contact your local DONA trainer (call DONA to get their name) and they can give you names and numbers of Doulas doing free work. Don't let you and your partner birth alone.
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#21 of 26 Old 01-13-2010, 09:54 AM
 
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#22 of 26 Old 01-16-2010, 05:03 PM
 
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I guess my 42+week 9lb12oz vbac baby didn't get the memo about having such a low chance of successfully being born because my homebirth with him was just great. I did have to push myself into active labor with some castor oil, mostly for my own benefit after several evenings filled with strong contrax that stopped when I went to bed. Remember that almost all the stats you find about vbac are in hospitals with at least some portion of the women recieving pitocin at some point, which I personally believe is about the most dangerous thing you can give a vbacer. As far as women who need it toward the end, I'd ask them when the last time they had gotten anything to eat was. Since they starve you at the hospital and many vbacers go in early or get induced due to an antsy doc or giant baby on an ultrasound, I'd guess that those who "needed" pitocin close to delivery might have just needed some calories since thats the stuff that muscles use to work effectively, not just hormones synthetic or natural.

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#23 of 26 Old 01-16-2010, 05:57 PM
 
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Since they starve you at the hospital and many vbacers go in early or get induced due to an antsy doc or giant baby on an ultrasound, I'd guess that those who "needed" pitocin close to delivery might have just needed some calories since thats the stuff that muscles use to work effectively, not just hormones synthetic or natural.
I'm one of those that had pit towards the end of labor. The calorie thing might be true. However, I know that I wouldn't have been able stomach anything during labor because I was just in too much pain.

Cat (30) DH (30) Carissa Grace born 11/3/07 via c/s after fetal distress. Sophia Claire born 10/9/09 VBAC!
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#24 of 26 Old 01-16-2010, 08:05 PM
 
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I'm one of those that had pit towards the end of labor. The calorie thing might be true. However, I know that I wouldn't have been able stomach anything during labor because I was just in too much pain.
This was one of the worse things I did in my labor. I didn't eat well, and hydrated only a little. Even sips of broth/soup can do an amazing thing on a stalled labor.
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#25 of 26 Old 01-17-2010, 11:58 AM
 
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I had an induction for my vbac at 40+3 due to rupture of membranes with no other progress. It was both hospital and my midwife's protocol to do so, at the time. The hospital no longer does vbacs, sadly, because EVERYONE there, including the OB who supports the midwives, and did my first section, was very supportive of vbacs. At some point, my blood pressure dropped really low (after 10 hours of heavy doses of pitocin and contractions one on top of the other I opted for an epidural and it caused a severe drop in BP), and the OB was called, and he stayed for the duration, with the midwife, never leaving my side, but also not ONCE suggestion the surgery. While I"m disappointed at how my birth went, I did not have the option for a homebirth and this was the only midwifery practice available. Anyway, I would do the induction again if it meant a vbac. Right now I can't even find comfort with a combination of care providers for my situation (already had a vbac and expecting another), and none of the OBs in the community I have to deliver at now will induce. I live 120 miles from the hospital, the weather will likely be really crappy in April (snow, freezing rain, etc), and I always go past my due date with a rupture of membranes and no contractions.
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#26 of 26 Old 01-18-2010, 09:38 PM
 
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We used pitocin in my last 2 births. I went in at 39 wks, 4 cm and 0 station and she was born 3.5 hrs later. I was 40 wks next time, 5cm and 0 station and she was born 2 hrs later. I would rather have pitocin than schedule a c/s at any week I think (this is not why we used pitocin for my births).

Jennifer, LPN and nursing student, Doula, CPST, and VBAC mama x3 to
AJ (5/03), Evan (12/04), Ilana (11/06), Olivia (2/09), and Unity (8/2012)

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