Q about induction for VBAC - Mothering Forums

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#1 of 16 Old 11-23-2006, 01:32 AM - Thread Starter
 
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Ok, after reading posts the past couple days it seems all are opposed to induction (at least using drugs that is.) Well, from day 1 of this pregnancy my midwife (who does deliver in a hospital only) has said he'd recommend we do a u/s at 36 weeks to decide when to induce me (he said between 37-39 weeks) as I'd have better chances of a VBAC if I have a smaller baby. He said it was unlikely that he'd allow me to try a VBAC after 39 weeks (of course my plan is to not sign the concent forms for a c-section unless the baby or I are actually in a true emergency as we were last time- regardless of how many weeks!) DS was 8 days early (we were doing infertility treatments with him as well as this one so we're 100% sure of due date) and he was 8 lbs 15 oz and 22.5 inches (keep in mind I'm only 5'2"!) I also had the vertical uterine incision with him since it was a life or death emergency delivery. So I don't know how much that has to do with it.

On one hand I'm very happy with the idea of being induced as I can be more relaxed knowing the timing (stress/nerves was a big contributor to things last time) and I'll be sure its my midwife there (he was on vacation last time.) On the other hand I REALLY want a VBAC more than anything and worry that induction will decrease my chances rather than increase them.

My plan is (and is subject to change!) to have the u/s at 36 weeks and get his recommendation then go in for acupuncture treatments for several days prior to whatever he schedules for the induction to use that to get things going a little more naturally.

So, I'm wondering what your thoughts are on this? I'm not a crunchy granola type person opposed to drugs at all (I'll all for an epidural or other pain meds!) but I do want a VBAC terribly. If you have sites/resources for me to visit on this I'd love to get educated
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#2 of 16 Old 11-23-2006, 01:37 AM
 
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Induction seriously raises the chance of rupture. No way I'd ever consent to an induction with a vbac. If you want a vbac, you'd do best to avoid an epidural also. They greatly increase the chance of section.

-Angela
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#3 of 16 Old 11-23-2006, 01:40 AM
 
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Originally Posted by estirbunny View Post
Ok, after reading posts the past couple days it seems all are opposed to induction (at least using drugs that is.) Well, from day 1 of this pregnancy my midwife (who does deliver in a hospital only) has said he'd recommend we do a u/s at 36 weeks to decide when to induce me (he said between 37-39 weeks) as I'd have better chances of a VBAC if I have a smaller baby. He said it was unlikely that he'd allow me to try a VBAC after 39 weeks (of course my plan is to not sign the concent forms for a c-section unless the baby or I are actually in a true emergency as we were last time- regardless of how many weeks!) DS was 8 days early (we were doing infertility treatments with him as well as this one so we're 100% sure of due date) and he was 8 lbs 15 oz and 22.5 inches (keep in mind I'm only 5'2"!) I also had the vertical uterine incision with him since it was a life or death emergency delivery. So I don't know how much that has to do with it.

On one hand I'm very happy with the idea of being induced as I can be more relaxed knowing the timing (stress/nerves was a big contributor to things last time) and I'll be sure its my midwife there (he was on vacation last time.) On the other hand I REALLY want a VBAC more than anything and worry that induction will decrease my chances rather than increase them.

My plan is (and is subject to change!) to have the u/s at 36 weeks and get his recommendation then go in for acupuncture treatments for several days prior to whatever he schedules for the induction to use that to get things going a little more naturally.

So, I'm wondering what your thoughts are on this? I'm not a crunchy granola type person opposed to drugs at all (I'll all for an epidural or other pain meds!) but I do want a VBAC terribly. If you have sites/resources for me to visit on this I'd love to get educated
I think you find a lot online indicating that induction for a VBAC is not a good idea. I think 36-37 weeks is way too early to even consider induction unless you have a valid medical reason. If you are not at all ready, you will end up exactly where you dont want to be, the OR. You might as well just plan a csection in that case. They only way they will know your baby is ready at that stage too is by doing an amnio. I just dont see why you would submit yourself to that unless it was medically indicated.
Pitocin is a big no no for a VBAC. Especially to get labor started. I have heard that using small doses of pit once labor begins if things begin to stall out is a safer alternative but I've yet to read anything concrete on that. Using Pit will increase the rupture rate but without it its around 1%.
I am sure others here can provide resources for you about VBAC that will list why induction is a bad idea.
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#4 of 16 Old 11-23-2006, 01:45 AM
 
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I highly recommend visiting www.ican-online.org to do some research.
Personally, I would drop that guy like a hot potato. First, he's suggesting that an 8lb 15oz baby is/was too large, which IMO is ridiculous. Second, he's suggesting inducing you, which he should know very well will almost double your risk of uterine rupture. Your baby will come when he or she is ready and inducing strictly for low birthweight is very risky IMO.
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#5 of 16 Old 11-23-2006, 01:48 AM
 
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I don't have the research available but induction increases your chance for a c/s and for a rupture. I will search around when I get a moment and see what I can find.
Induction would increase your chance of a c/s just because if your body isn't ready then an induction is not going to work-or work too slowly for your mw's and hospitals liking.

Personally I would not get an u/s done. They can be off by a pound or more either way so they can easily set you up for a repeat c/s telling you your baby is too big when that might not be the case. So if you do get one I would at least keep that in mind.

I am always leary of dr's who say they are in favor of vbac's but you have to go into labor before 39 weeks (I actually am leary when they put any time constraint). The majority of women aren't going into labor before 39 weeks so it is limiting your chances right there.

I am not trying to convince you of not having an epidural but if it is at least an option for you it will help in the pushing phase so you can squat etc to help open your pelvis tremendously.

Just throwing out some ideas out there for you!

Also, IF there is a increased risk of UR with a vertical incision ( I don't know about this so I can't comment on it, I wouldn't let anyone induce me because that adds to your risk.
ETA-here is one article I found
http://www.vbac.com/uterine.html
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#6 of 16 Old 11-23-2006, 02:29 AM - Thread Starter
 
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Thanks for the links... yep, I have the inverted T shaped scar (they cut horizontal for the skin and part of uterus, lifted up, then vertical for the uterus to get him out faster.) So that says the chances are around 4-9% rupture.

Honestly though- I'd rather have a VBAC and rupture than not have a VBAC at all. Does that make any sense? Ruptures don't mean you can never have more children (even though I think we're done having children anyway). Am I completely nuts to prefer rupture over c-section?!
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#7 of 16 Old 11-23-2006, 03:01 AM
 
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So if you have a 4-9% chance already, then you will have a higher chance or UR if they added in an induction.
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#8 of 16 Old 11-23-2006, 10:11 AM
 
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Originally Posted by estirbunny View Post
Thanks for the links... yep, I have the inverted T shaped scar (they cut horizontal for the skin and part of uterus, lifted up, then vertical for the uterus to get him out faster.) So that says the chances are around 4-9% rupture.

Honestly though- I'd rather have a VBAC and rupture than not have a VBAC at all. Does that make any sense? Ruptures don't mean you can never have more children (even though I think we're done having children anyway). Am I completely nuts to prefer rupture over c-section?!
I personally think you are nuts to prefer rupture over a csection since there are women who lost their babies due to a rupture. Not only that a rupture can cause you not only to lose your baby, but your reproductive parts as well. Not to mention the many problems it could do to you health wise. This really makes no sense to me at all.
I am pretty shocked that with that sort of incicion an OB is even considering a VBAC with you based on your other outcome and your incision, then to further suggest an induction???!!! That seems really insane. I can see where he is concerned about the weight and going post dates due to the vertical incision, but an induction with Pit. good grief -- thats just insane with a vertical incision.
Keep in mind that rupture rate for a vertical incision is based on several things, one that does not include induction.
You also mentioned that a rupture doesnt necessarily mean you cannot have more children. This is right, it doesnt, but it does increase your chances of rupture again, infertility, premature birth, placental acretia and previa, and the list goes on.
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#9 of 16 Old 11-23-2006, 10:49 AM
 
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It is INSANE to prefer rupture to repeat section! Many rupture babies die! I understand wanting a VBAC badly, but c'mon! Also, I'd drop that midwife, she sounds very...well, not educated. Go for the VBAC, stay away from induction & epidural...but don't say you'd risk your babies life to avoid the surgery!

~Marie : Mom to DS(11), DS(10), DD(8), DD(4), DD(2), & Happily Married to DH 12 yrs.!
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#10 of 16 Old 11-23-2006, 12:58 PM
 
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Also, if you rupture, there WILL be a section. You will be cut open. You're not avoiding that.

-Angela
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#11 of 16 Old 11-23-2006, 02:11 PM
 
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Do you mean that you prefer the *chance* of rupture with VBAC over the risks of another cesarean? I wouldn't say that's crazy...many people do. Your risk level with the vertical incision depends on how high the incision went. If it's up into the fundus (the thicker, muscular area of the uterus), your risk of rupture is quite a bit higher. If it's vertical but all in the lower segment, the risk is comparable to a low transverse incision.
Regardless, with the vertical issue especially, I would avoid all types of induction. It really does raise the risk of rupture by quite a bit. Not to mention that it raises the risk of another cesarean by quite a bit, as well - forcing your body to labor when it isn't ready is asking for trouble, unless there's an urgent medical need. For me, in the case of a baby who needed to come out ASAP due to life-threatening health issues, I'd choose a repeat cesarean over an induction.
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#12 of 16 Old 11-24-2006, 11:52 AM
 
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I'm also really surprised that they would advise induction for you. Even with a low transverse scar, it's not recommended for a VBAC.
I understand you wanting to have a VBAC though and rupture does not necessarily equal instant fatality for the baby or for you (mothers die from rupture too). It's not like an explosion...there are signs and signals that competent professionals (or an educated you) can decipher and then yes you'd end up with a c section.
Good luck!
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#13 of 16 Old 11-24-2006, 01:58 PM
 
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When did you go into labor last time? What was the reason for the first c/s. I ask because this can be an indicator of your prognosis for a successful VBAC.

An ultrasound at 36 weeks is very inaccurate in terms of dating or size estimates - can be off by several weeks and several pounds. So, determing at 39 week induction based soley on an ultrasound seems shaky at best.

The use of pit/cytotech and your scar type does increase the risk of rupture. A BIG baby does not increase your risk of rupture. So, if you really want a VBAC I would avoid the induction completely.

Have you considered shopping around for a provider who is less eager to use interventions?
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#14 of 16 Old 11-24-2006, 02:22 PM
 
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Originally Posted by estirbunny View Post
Ok, after reading posts the past couple days it seems all are opposed to induction (at least using drugs that is.) Well, from day 1 of this pregnancy my midwife (who does deliver in a hospital only) has said he'd recommend we do a u/s at 36 weeks to decide when to induce me (he said between 37-39 weeks) as I'd have better chances of a VBAC if I have a smaller baby. He said it was unlikely that he'd allow me to try a VBAC after 39 weeks (of course my plan is to not sign the concent forms for a c-section unless the baby or I are actually in a true emergency as we were last time- regardless of how many weeks!) DS was 8 days early (we were doing infertility treatments with him as well as this one so we're 100% sure of due date) and he was 8 lbs 15 oz and 22.5 inches (keep in mind I'm only 5'2"!) I also had the vertical uterine incision with him since it was a life or death emergency delivery. So I don't know how much that has to do with it.
First off, you have a male midwife??!! Wow!

2nd....no way should a vbac be medically induced, especially for the reasons stated above. I would seek out another provider, as this one seems to be setting you up for failure.
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#15 of 16 Old 12-02-2006, 01:53 AM - Thread Starter
 
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Sorry for just replying now- thanks for all your replies! Of course I mean with everything else being equal and baby being completely heathly either way I'd rather take the risk.

But seems it may not be an option now... we'll see. This baby is frank breech and I'm doing everything possible to try to get her to turn including chiropractic twice a week. So, now the u/s at 36 weeks will be to confirm her position. If she is breech they'll do another one at 38 to see if she has turned or if they'll need to try an external version/ schedule a c-section /induce.

Right now my midwife (yep a GUY!) says she seems to be small enough that we won't need to worry too much about induction for size, but he still thinks it would be a good idea given my medical history to try to naturally induce (well, as naturally as you can) starting sooner because he feels I'll have a better chance with induction of a 7lb baby than no induction and another 9lb'r (I know 9lbs isn't huge, but apparently my frame really isn't well suited for big babies... I take that with a grain of salt.) He's given the OK for acupuncture so we'll give that and sex a go before we do drugs. Again, thanks for all the input and support (even if you disagree its still nice to hear your ideas!!)
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#16 of 16 Old 12-02-2006, 02:22 AM
 
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I would RUN away from that "medwife" as fast as possible. He is setting you and your child up for some serious complications.

A repeat csection would be the safer route to go. I agree with those who think it's "nuts" for you to even consider an induced vbac, but it's totally your decision and I hope it all works out well.

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