Planning VBAC, 41 w 3 d -- HELP - Mothering Forums

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#1 of 26 Old 05-17-2006, 10:49 PM - Thread Starter
 
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I am planning a VBAC, but am now 41 weeks and three days. My mw said I an go to 42 weeks and 1 day, but will then have to be sectioned. She said I may be able to try a Foley baloon or a little pitocin depending upon who is on that day. Is it worth the risk?

Why am I not going into labor? I did go into labor with ds and he wasn't even late. I really want to experiene a natural birth, but I don't want to put my baby at risk either.

Thanks for any support or advice mamas!
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#2 of 26 Old 05-18-2006, 12:10 AM
 
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Moved to VBAC...

anna kiss partner to jon radical mama to aleks (8/02) and bastian (5/05)
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#3 of 26 Old 05-18-2006, 12:14 AM
 
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My mw said I an go to 42 weeks and 1 day, but will then have to be sectioned.
Why? I went to 43 weeks with an OB.

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#4 of 26 Old 05-18-2006, 12:19 AM
 
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Is baby moving as usual? Is there a concern about your baby, not just the dates? If baby is fine, then I vote you don't show up for it if they schedule it. Your baby will come when it's ready. They cannot drop you without 30 days notice unless they transfer you to an equivalent provider. And do you think you'll have this baby in less than 30 days? Probably. You CAN do this. A c/section is a procedure and as a patient you are entitled to refuse any procedures. Maybe you can placate them with a non-stress test, if you feel the need. If not, just let your machine get your calls and gestate in peace waiting for your new arrival!

Babies come when they are ready. Pitocin increases your risk of uterine rupture by 10%. A good Dr will not use pitocin. You also have a right to decline pitocin as much as the c/section. Have you been to ICAN's site? Try starting with their 'white papers' here:
http://www.ican-online.org/resources...pers/index.php

Imo, pitocin is not worth the risk and is only the beginning of a cascade of interventions. The contractions it induces are NOT normal and quite painful. Very few women can do natural with pitocin.

Is there any question about your EDD? Do you know exactly when you ovulated? If so, then that could be the reason labor hasn't begun yet. You've already gone into labor once. You know your body can labor. All you have to do is wait for baby to pick his/her birthday!
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#5 of 26 Old 05-18-2006, 12:26 AM
 
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Quote:
Originally Posted by kstsmith
Pitocin increases your risk of uterine rupture by 10%. A good Dr will not use pitocin. You also have a right to decline pitocin as much as the c/section. Have you been to ICAN's site?
Actually, a lot of very good doctors will use low-dose pit in order to avoid a section. A cervical Foley will often work well for cervical ripening and carries few risks.

There is some very good data that the risk of mortality goes up significantly after 42 weeks. Everyone will have a story of someone they know who went to 43 weeks and was fine, but looking at large studies, the risks do increase.

I would seriously consider the Foley, followed by low-dose pit. If I don't go into spontaneous labor by 41 1/2 weeks, that's our plan.

mama to Max (2/02) and Sophie (10/06); wife to my fabulous girl
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#6 of 26 Old 05-18-2006, 01:17 AM
 
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Here is another fact sheet on using pitocin from the Coalition for Improving Maternity Services:

http://www.motherfriendly.org/Downlo...fact-sheet.pdf

A quote from this document:

Women with prior cesarean sections have a slightly increased probability of the scar giving way withPitocin (oxytocin) induction (8 per 1,000 vs 5 per 1,000 with spontaneous labor onset) and greatlyincreased risk when prostaglandins (24 per 1,000) are used for cervical ripening or induction.20
Prostaglandins include Cytotec (misoprostol), Prepidil (prostaglandin E2), and Cervidil (prostaglandin E2).

It's important to have all of the information when making your decision, especially since you asked if it was worth the risk. I wish I had known all of this with my first and I might not have had a c/section. If I had known I had a 50/50 chance of surgery simply by using pitocin, then I might have declined it. So, in my experience, no, it is not worth the risk. And after learning of the increased risk for women with prior c/sections pitocin is not worth the risk then, either. There are many things you can try that are much less risky for inducing labor. Walking-lots of it, sex (natural prostaglandins in semen), nipple stimulation, etc. I've only recently learned of the foley catheter, so I don't really have much knowledge or experience with it, but from what I have heard it is less risky than pitocin. Anyway, read as much as you can and then make the decision that fits you the best. Remember that once you agree to one intervention, it can sometimes lead to a cascade of interventions if it doesn't work.
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#7 of 26 Old 05-18-2006, 02:57 AM
 
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Foley catheter worked like a charm for me and my VBAC. It's not comfortable, but mine was in at 6 pm and I was in active labour at 11 pm. Wowee!

And then I pulled it out. Pop! Also, I thought that prostaglandin gel is the thing to not use for a vbac...something about the scar tissue being similar to cervical tissue.

Kate: fumbling through the best years with W, L, F & V...newest arrival coming Jan '11
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#8 of 26 Old 05-18-2006, 03:00 AM
 
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Quote:
Originally Posted by maxmama
There is some very good data that the risk of mortality goes up significantly after 42 weeks. Everyone will have a story of someone they know who went to 43 weeks and was fine, but looking at large studies, the risks do increase.
Actually not until 43 completed weeks does the rate go up much.
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#9 of 26 Old 05-18-2006, 09:24 AM - Thread Starter
 
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I know they absolutely will not use any cervadil, other ripening agents. The only possibilities are pit and the Foley. I'm thinking the pit isn't even worth the risk. I am going tomorrow morning for a biophysical and my mw will try to sweep my membranes (she tried Tues., no luck). We'll see what happens. I am in NY and am pretty sure no one will be involved in a 43 week pregnany. I am also not sure I would take the risk.

I was so confident that if I just put faith in my body, all would be fine. It seems that perhaps I am among the small few who instead need medical intevention....

but how strange that I have a completely healthy,uneventful nine months and then just never go into labor!?!
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#10 of 26 Old 05-18-2006, 12:05 PM
 
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I do not have any advise, but I just want to offer you some encouragement. You can do this. Your body is perfect and your baby will be born soon. I know it is hard, but try to gestate peacefully. Stress can inhibit the starting of labor.

Please let us know how your labor and birth progress!

Heather, Mommy to Matthew 9/7/05 and Eli : 2/11/09
Birth Doula, Yarn Dyer and Knitter
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#11 of 26 Old 05-18-2006, 12:59 PM
 
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Quote:
Originally Posted by kstsmith
Here is another fact sheet on using pitocin from the Coalition for Improving Maternity Services:

http://www.motherfriendly.org/Downlo...fact-sheet.pdf

A quote from this document:

Women with prior cesarean sections have a slightly increased probability of the scar giving way withPitocin (oxytocin) induction (8 per 1,000 vs 5 per 1,000 with spontaneous labor onset) and greatlyincreased risk when prostaglandins (24 per 1,000) are used for cervical ripening or induction.20
Prostaglandins include Cytotec (misoprostol), Prepidil (prostaglandin E2), and Cervidil (prostaglandin E2).

It's important to have all of the information when making your decision, especially since you asked if it was worth the risk. I wish I had known all of this with my first and I might not have had a c/section. If I had known I had a 50/50 chance of surgery simply by using pitocin, then I might have declined it. So, in my experience, no, it is not worth the risk. And after learning of the increased risk for women with prior c/sections pitocin is not worth the risk then, either. There are many things you can try that are much less risky for inducing labor. Walking-lots of it, sex (natural prostaglandins in semen), nipple stimulation, etc. I've only recently learned of the foley catheter, so I don't really have much knowledge or experience with it, but from what I have heard it is less risky than pitocin. Anyway, read as much as you can and then make the decision that fits you the best. Remember that once you agree to one intervention, it can sometimes lead to a cascade of interventions if it doesn't work.
How do you get a 50/50 chance of a cesarean out of a rupture rate increasing from 5 per 1000 to 8 per 1000?

Also, my perinate did the original research on uterine rupture and prostaglandins v. pitocin (the 2000 study that scared the pants off everyone about VBAC) and even he will quite comfortably induce with low-dose pit.

mama to Max (2/02) and Sophie (10/06); wife to my fabulous girl
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#12 of 26 Old 05-18-2006, 02:02 PM
 
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Originally Posted by SugarAndSun

I was so confident that if I just put faith in my body, all would be fine. It seems that perhaps I am among the small few who instead need medical intevention....
Maybe, perhaps, it is possible your dates were off and you aren't even due yet? NO ONE is pg forever, and I really believe if they leave you alone, you will go into normal labor on your own. It always works.
Quote:
but how strange that I have a completely healthy,uneventful nine months and then just never go into labor!?!
I think patience is the key here. Most practioners would like women on some sort of schedule, but ya know what? Babies don't know what that is! So if someone wants to stay on a schedule, they should stay out of labor/birth!
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#13 of 26 Old 05-18-2006, 06:14 PM
 
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I am interested in reading the studies of the babies at risk over 42 weeks. From what I have read, most of the babies born with issues at 42 (and over) weeks, had other issues that were keeping them from being born on time -- the extra time in the uterus was not the cause of their issues once born. These babies would have been born with issues had they been born at 38 weeks. A gestational period can be 42 weeks -- everyone knows that, and some woman might not even have one at 42 weeks.

Your body can do it. If your baby is moving and active, try not to worry about what happens at 42 weeks!
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#14 of 26 Old 05-19-2006, 12:38 AM
 
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Originally Posted by maxmama

Also, my perinate did the original research on uterine rupture and prostaglandins v. pitocin (the 2000 study that scared the pants off everyone about VBAC) and even he will quite comfortably induce with low-dose pit.


I don't understand...your perinate did the research that scared the pants off of every doctor and he is quite comfortable w/ induction? This is very confusing to me.
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#15 of 26 Old 05-19-2006, 12:53 AM
 
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The study in 2000 (Easterling, Lydon-Rochelle, et al.) has limitations, the biggest of which is that the data comes from birth certificates (retrospective study) and doesn't distinguish between uterine dehiscence and frank rupture of the uterus (since neither the ICD-9 codes nor the coding on the birth certificates does either). The problem was that it was really the first research to quantify the increased risk of uterine rupture, and since the VBAC guidelines already required an in-house OB and anesthesia, it became a reason for docs to stop offering them and for malpractice fears to become more pressing (since now there was quantified research). The intent of the study was never to "outlaw" VBAC, or to prohibit induction (one of the coauthors is a CNM, FWIW), but in a climate already becoming unfriendly to VBAC, it was taken as a reason to stop doing them.

I HATED my perinate before I met him (because of this study), but after talking with him and a couple of his co-researchers, the intent of the study (and the context in which it ended up being taken) does make more sense.

mama to Max (2/02) and Sophie (10/06); wife to my fabulous girl
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#16 of 26 Old 05-19-2006, 01:03 AM
 
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Quote:
Originally Posted by SugarAndSun
I was so confident that if I just put faith in my body, all would be fine. It seems that perhaps I am among the small few who instead need medical intevention....

but how strange that I have a completely healthy,uneventful nine months and then just never go into labor!?!
I have to say this sort of made me sad to hear...Please don't lose faith in your body now. I had two babes born 2 weeks (c/s) and 1 week (vbac) "early" then with my 3rd - I went all natural and delevered her 41w6d22hours My mw was getting a little nervous but I agreed to do some non-stress testing just to keep everyones nerves at bay (inc. dh) - I ended up taking a SMALL dose of castor oil the moring I went into labor (1 tablespoon in a smoothie) after dicussing my options with my mw - but above all - I KNEW that my body would do what it was supposed to do! Keep up the positive thoughts!
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#17 of 26 Old 05-19-2006, 01:32 AM
 
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Im a big believer of waiting! With my DS we had so many dates by my date his EDD was 8th May and by an early scan it was 1st May. My midwife went by my dates and DS was still 10 days overdue or 18 days if you go with the scan date, born 18 May. I was offered a stress test but refused but had a stretch and sweep done on the 16th and went into labour 24hrs later.

Mumma to 6 wonderful kiddos + stork-suprise.gif due March 2013

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#18 of 26 Old 05-19-2006, 02:10 PM - Thread Starter
 
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They haven't been able to do a sweep since the internal ????? (forgot name) is closed, though the outer is open. I am thinking of trying castor oil, even though so many people say no.
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#19 of 26 Old 05-19-2006, 02:32 PM
 
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Originally Posted by maxmama
How do you get a 50/50 chance of a cesarean out of a rupture rate increasing from 5 per 1000 to 8 per 1000?
The 50/50 chance of a cesarean is just by using pitocin whether you have a previous scar or not, not from the UR rate. If you read the first bullet under Hazards of Induction, you'll find:

"First-time mothers have approximately twice the likelihood of cesarean section with inductioncompared with natural onset of labor. This risk is due to the procedure itself, not any reason that mighthave led to inducing labor.9 Inducing labor at 41 weeks in a hypothetical population of 100,000 first-time mothers will result in somewhere between 3,700 and 8,200 excess cesareans and cost an extra $29to $39 million.17"

I was a first time mother when pitocin was used (among other things) to stimulate labor. I was one of the 50% that resulted in a c/section. Earlier, I only copied the portion that related to the risk of UR, and left the link for those that wanted to read further.

ETA: The side effect of hyperstimulation of the uterus is the main reason the c/section rate increases with use of pitocin. This is also the reason the UR risk increases. The prostaglandin gels also cause hyperstimulation of the uterus, and I've read that they are worse than pitocin, but pitocin also carries the same risk. Someone sent me a link to the drug fact sheet for pitocin (you know...the manufacturer's insert that's supposed to come with every prescription), and it was a very interesting read. It's just plain scary how liberal it's use is.
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#20 of 26 Old 05-19-2006, 10:05 PM - Thread Starter
 
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Well I will be 42 weeks on Sunday and I am schedules for a c/s at 10:30 am. I am trying the castor oil tonight (2 ounces with some OJ). Maybe it will work.
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#21 of 26 Old 05-19-2006, 10:13 PM
 
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Babies do know when they are ready, and what if your labor would have started at 42 weeks, 1day? If baby is ok, and mom is ok....how do you feel about waiting?

I know at 42 weeks sex is not appealing at all. You can always tell your dh "don't worry about me, just do what you've gotta do" so you can get some prostaglandins in there! Start the nipple stimulation now. It takes a lot of it to work. Do you have a breast pump? If not, do you know how to manually express milk? Either of those will work for nipple stimulation. I'm sorry you are having to go through this when you could be waiting for your baby.

Have you checked the www.gentlebirth.com archives for info about postdates? Here's a link if you are interested:
http://www.gentlebirth.org/archives/postdates.html
Lots, lots of info about postdates, protocols, testing, etc. The info there may help you decide whether going in for the c/s is right for you. And that's only something you can do.
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#22 of 26 Old 05-19-2006, 10:29 PM - Thread Starter
 
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Quote:
Originally Posted by kstsmith
Babies do know when they are ready, and what if your labor would have started at 42 weeks, 1day? If baby is ok, and mom is ok....how do you feel about waiting?

I know at 42 weeks sex is not appealing at all. You can always tell your dh "don't worry about me, just do what you've gotta do" so you can get some prostaglandins in there! Start the nipple stimulation now. It takes a lot of it to work. Do you have a breast pump? If not, do you know how to manually express milk? Either of those will work for nipple stimulation. I'm sorry you are having to go through this when you could be waiting for your baby.

Have you checked the www.gentlebirth.com archives for info about postdates? Here's a link if you are interested:
http://www.gentlebirth.org/archives/postdates.html
Lots, lots of info about postdates, protocols, testing, etc. The info there may help you decide whether going in for the c/s is right for you. And that's only something you can do.

I've been walking, planting trees, using dh and nursing ds1. No luck. This castor oil is my hope tonight.

I am nervous to wait. My mw won't schedule the section for later in the week. What if I risk to life of my babe? I am an hour from the hospital and risk going to a HORRIBLE hospital near home if I wait. I am trying to weight the risks and benefits.
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#23 of 26 Old 05-19-2006, 10:34 PM
 
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It sounds like you are in such a tough spot, not to mention being ready to meet your baby! Enjoy your weekend as much as possible and keep doing all you have been doing only if you feel like it. Sending lots of labor vibes your way!!
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#24 of 26 Old 05-19-2006, 10:36 PM
 
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Quote:
Originally Posted by kstsmith
The 50/50 chance of a cesarean is just by using pitocin whether you have a previous scar or not, not from the UR rate. If you read the first bullet under Hazards of Induction, you'll find:

"First-time mothers have approximately twice the likelihood of cesarean section with inductioncompared with natural onset of labor. This risk is due to the procedure itself, not any reason that mighthave led to inducing labor.9 Inducing labor at 41 weeks in a hypothetical population of 100,000 first-time mothers will result in somewhere between 3,700 and 8,200 excess cesareans and cost an extra $29to $39 million.17"

I was a first time mother when pitocin was used (among other things) to stimulate labor. I was one of the 50% that resulted in a c/section. Earlier, I only copied the portion that related to the risk of UR, and left the link for those that wanted to read further.

ETA: The side effect of hyperstimulation of the uterus is the main reason the c/section rate increases with use of pitocin. This is also the reason the UR risk increases. The prostaglandin gels also cause hyperstimulation of the uterus, and I've read that they are worse than pitocin, but pitocin also carries the same risk. Someone sent me a link to the drug fact sheet for pitocin (you know...the manufacturer's insert that's supposed to come with every prescription), and it was a very interesting read. It's just plain scary how liberal it's use is.
I have read the insert, since it's a medication I use daily at work. I also wonder at the 50/50 cesarean chance, since many of our primips are induced and we still have a section rate of around 15%.

I trust pit more than prostaglandins, because it is so controllable. Increase rates should not be set at less than q 20 minutes, because that's when you get maximum physiologic response. I also run my pit very slowly and up it very gradually; I can't remember the last time I ran pit above 10 mu/min.

I think pit is demonized when a lot of the hyperstim comes from increasing the dose too rapidly or too far. The Dublin Maternity Hospital model was partially adopted in the US, and they do use high-dose pit on primips with a very low section rate.

mama to Max (2/02) and Sophie (10/06); wife to my fabulous girl
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#25 of 26 Old 05-20-2006, 12:30 AM
 
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Quote:
Originally Posted by maxmama
I have read the insert, since it's a medication I use daily at work. I also wonder at the 50/50 cesarean chance, since many of our primips are induced and we still have a section rate of around 15%.
I think that is great that your hospital judiciously uses pitocin. It's even better that the c/s rate is about 15%. However, most of the US has a c/s rate double that of your hospital, and in some places it is more than double. I also agree that it is less risky than artificial prostaglandins.

More info on the increased risk of c/section with pitocin:

http://www.medscape.com/viewarticle/532314
based on this study from pubmed
http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum

http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

I know there's more out there, but I'm not sure the debate about the 50% increase in c/s rate with pitocin use applies to the OPs concerns. Maybe a new thread would be best considering what is happening with her this weekend?
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#26 of 26 Old 05-20-2006, 12:45 AM
 
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Here my wishes for you. Rent some movies, take a bubble bath, get quiet and go inside yourself. Talk to this baby. Anxiety ~ stress ~ fear ~ are all the things that will also postpone this baby receiving the message that it's okay to come now. Andrenalin is the enemy at this point, get the oxytocin flowing. Snuggle and Snuggle and Snuggle with dc and dh.
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