Would you choose VBAC & induction over a repeat c/s? - Mothering Forums

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#1 of 25 Old 12-16-2006, 10:22 PM - Thread Starter
 
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Just curious. It's probably too early for me to be thinking about this, but I asked my ob last time and she said she'd feel comfortable enough inducing me with pitocin as long as my cervix was favorable if I got to 42 weeks (GAWD I love my OB!).

I'm just beginning my information search, so I know a lot of you are likely more educated than me in this matter. I always thought I'd be worried about the consequences of a vbac induction but looking forward in time, I think I'd much rather be induced and "risk it" than suffer another c/s...

What do y'all think? Is it worth the risk?
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#2 of 25 Old 12-16-2006, 10:34 PM
 
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What I AM choosing next time is to birth at home.

If my only 2 choices were induction or repeat section I would choose the section.

~Marie : Mom to DS(11), DS(10), DD(8), DD(4), DD(2), & Happily Married to DH 12 yrs.!
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#3 of 25 Old 12-16-2006, 10:43 PM
 
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I had a VBAC last time and the OB offered to break my water this time if I didn't want to have a Christmas baby. (Since I'm a "proven VBAC"). No way would he have done that last time, though. I declined but I would probably choose breaking my water first over Pitocin. I would also try Castor Oil before that.

All that said, I had a low dose Pitocin with my last VBAC to augment labor. It was that or c-section. I'm so, so glad that I chose the Pit. I had an awesome VBAC that I wouldn't trade for the world. The statistics ARE greater that you could rupture with Pit but it's not really that much. My OB was very careful not to give me much and it worked enough to keep my c-section away.
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#4 of 25 Old 12-16-2006, 10:44 PM
 
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My response is the same as pp. I am due at the end of Jan and have told my OB (whom I love) that I would rather have another CS instead of going through an induction again - that ultimately led to a section anyway. My induction (cervadil) was the most painful and frightening experience. Surgery recovery was a piece of cake compared to it. I am hoping for a natural VBAC this time, however.
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#5 of 25 Old 12-16-2006, 10:51 PM
 
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Gosh that is such a toughie. I think I would opt to go past 42 weeks (since she can't make you get an induction or c/s at 42 weeks) then either an induction or a c/s. But if those weren't my options I don't know. I guess I would do an augmentation, where they start the pit out at a low dose and then turn it off and see how I am doing.
Hopefully you won't have to make that decision though. I swore I was going to go "overdue" and had my mind all set on that. Little did I know I would have my vbac the day before my due date!
Good luck!
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#6 of 25 Old 12-17-2006, 12:31 AM
 
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If the choice was "induce or slice" I'd vote "induce". However...

One thing to keep in mind is that "chemical" inductions (using an oxytocin like pitocin, 0r a prostaglandin, or even worse misoprostol/"cytotec") increase the chance of uterine rupture...the big "bugaboo" of the VBAC process, and something your care provider should be aware of already. Although some studies show that once labor is actively moving along the use of oxytocin to enhance labor isn't as risky, using chemical methods to induce a VBAC mama is considered unacceptably risky by many members of the medical community due to that increase in UR risk. And many VBAC mamas consider it out of the question since it also increases your chance of another c/s.

Check out the VBAC websites in the sicky at the top of this forum for links to studies and statistics about the use of chemical induction methods. But a few to look at might be http://www.homebirth.org.uk/vbacinduction.htm (though their studies are a bit old...the two oldest studies show no significant increased risk, but all their more recent studies show higher UR risk with chemical induction) and http://www.worldserver.com/turk/birt...bac2005-9.html has hundreds of scholarly studies with "layman's terms" summaries of the findings...a great resource for VBAC information you can share with a doctor.

If you absolutely positively need to be induced (due to an actual problem with your babe or a problem with your own health and not just an antsy doctor), ask your doctor about using a foley catheter/balloon to manually induce labor. If the only reason to induce is that you're getting into your care provider's "grey area"...ask them what exactly their concerns are about your going past 42 weeks. Would they be content with your doing NST or a twice daily fetal kick count? An u/s to determine adequate blood flow through the placenta/umbilical cord? Simply hitting the 42 week mark doesn't make you any more "high risk" (assuming no other compliations) and any induction makes a second c/s more likely. So ask them if they would consider safer options...like a Foley, or a "wait and start naturally" approach.

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#7 of 25 Old 12-17-2006, 12:40 AM
 
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I have been considering the exact same issue. I was induced the first time at 42 weeks with cervical gel and then pitocin. Thirty hours later, after many many complications, A LOT of pain, a screwed up epidural, etc. I had a C/S and never got past 2 centimeters anyhow. I was not effaced or dialated at all at the time of the induction.

Ok - so new OB, desire to VBAC. I find myself wondering what will happen this time if I hit 42 weeks.... I've pretty much decided that I will have a repeat c/s if it comes to that. I am just so scared of the pain of the pitocin (and I did like 17-20 hours unmedicated the first time around) and all the problems that came secondary to induction/interventions. I had a horrible recovery and I am sure that some of that is due to the physical trauma of the induction. I don't WANT another c/s but at 42 weeks I'm planning to throw in the towel.

Ok - actually, if my cervix looks "favorable" - as in effaced and some dialation I'll ask about a foley. But I'm really opposed to the pitocin. My rupture concerns with pit are minimal, as the PB says the risk is actually not increased much and the pit can easily be stopped (v.s. cervical gels which are unstoppable once applied).
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#8 of 25 Old 12-17-2006, 02:21 AM
 
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Originally Posted by rmzbm View Post
What I AM choosing next time is to birth at home.

If my only 2 choices were induction or repeat section I would choose the section.
Me too probably because induction is just way too dangerous of a choice for me, but I am definitely going to be going for an HBAC if we decide to have another baby. I've talked to a couple of midwives about natural methods of induction and many seem okay with using EPO and Dr. Christopher's formula or homeopathics if it ever came to that (I may think about doing it just to be proactive because I went 3 weeks over my due date with my dd).
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#9 of 25 Old 12-17-2006, 02:32 AM
 
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I would absolutely take another c/s over being induced- no matter what type of induction they use!!! any kind of induction with a previous uterine scar, greatly increases your chances of having a rupture....and let's face it- probably most of us here had a c/s because we were induced to begin with!!! : - if you're not "ready to go" inducing isn't going to help anyways!!

Here's an awsome article that I personally think every pregnant woman (and their partners) should read:


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

Dani
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#10 of 25 Old 12-17-2006, 11:51 AM - Thread Starter
 
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Thanks for all your responses! It's interesting to see such a varied response!

When I was induced with my son, it was due to meconium being in my water when it broke (contractions never started on their own) at 41 weeks. My cervix was very infavorable - not effaced or dilated whatsoever and he was -3 station... he was also posterior, asynclitic and had the cord around his neck 3 times. I figure, that can't POSSIBLY all go wrong again right?

Although I'd love to VBAC, the only way I'd be able to have a HBAC is by UCB (which I refuse to even consider). The midwives in my area won't touch VBAC's at all (even in hospital - they don't have VBAC rights at the hospital that they have rights to work at), and I don't drive so I wouldn't be able to get to the midwives for my appointments. My partner is also extremely unsupportive of homebirth anyway, so I doubt it would be a possibility.

I'm just SO lucky I've found such a "crunchy" OB. She really is awesome, and I think even if I was at 42 weeks, if baby was doing well she'd consider allowing me to continue... I guess we'll see! Hopefully baby will decide to come earlier and I won't have to think about it!
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#11 of 25 Old 12-17-2006, 02:10 PM
 
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Definitely consider going past 42 wks... do NST if you need to be made to feel reassured that babe is doing ok (but note that things like afi aren't necessarily accurate). But if you find you need to induce, it can be done

I was induced at 37 wks due to blood incompatiblity on a very infavorable cervix. They used a foley catheter to get my cervix favorable and i did manual nipple stimulation to get contractions going. I eventually used a breast pump for nip stim and it kicked me into active labor. No pit, no cervadil, no chemicals. I had a vba2c.

Midwifery Student and Mama to 2 daughters and 3 sons.     
ribboncesarean.gif vbac.gifhomebirth.jpg I have given birth a variety of ways and I am thankful for what each one has taught me.

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#12 of 25 Old 12-17-2006, 03:11 PM
 
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For myself, I would choose induction long before I chose a repeat c/s. There are many natural ways to ripen your cervix and help induce labor. Personally, I have found that primrose oil works wonders to ripen your cervix. Also, to me the risks of low-dose Pit are more acceptable than just going under the knife without experiencing labor at all.

I was induced with Cervadil for my first labor, and it didn't cause any contractions. Of course, I only had it in for about 3 hours before my water broke, so they had to remove it. I went on to give birth vaginally about 24 hours after the Cervidil was first used. Yes, I did end up with pit because my natural contractions weren't progressing enough. The pitocin sucked and I really want to avoid experiencing it again, but if it is a choice between a few hours of Pitocin and weeks of pain recovering from a c/s, I will take the Pitocin.

My second labor was also an induction that ended in a c/s, but for completely necessary reasons. The cord was short and around my son's neck 3 times and he physically was unable to descend. I made it to a 10 and was pushing, but he just couldn't descend enough for them to even attempt to use a vacuum or anything. Thankfully they tried everything they could before resorting to the c/s, so I have no regrets.

Currently, I am in the "negotiation" stages of my current pregnancy, which will be my first VBAC (and also my last pregnancy). I was due yesterday. So even though I have a very VBAC friendly OB who is totally unconcerned about me going postdates, we are running into the whole "Holiday Induction Rule", which my OB is pushing for an induction on the 22nd to avoid me having to be in the hospital on Xmas (and perhaps end up with a different OB if she's not on call). Right now, I would rather risk ending up in the hospital on Xmas than be induced for convenience sake, and thankfully, I have a doula who is just as passionate about this as I am (she herself has had 2 VBACs)

Overall, I think you need to do your research and decide what is best for you. No one can tell you which choice is best. Good luck!
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#13 of 25 Old 12-18-2006, 01:09 AM
 
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Well I would consider a foley catheter induction, but beyond that I would choose the section over the induction.
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#14 of 25 Old 12-18-2006, 01:15 AM
 
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I chose induction with super low dose of pit over a c/s with my last birth, and if you do a search on this forum you'll read the wonderful story of how that turned out It was by far my best birth, completely unmedicated and natural (except for the small dose of pit, that is, LOL!) I thought long and hard about this decision (had nothing better to do the 4 days I was in the hospital between when my water broke and babe was born!) In the end, we decide to do the pit because I was already having contractions, just not in a good labor pattern, and it really only was going to take a very small dose to get me going.
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#15 of 25 Old 12-18-2006, 10:20 AM
 
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For me, having had 2 cesareans, I think an induction would be more risky than a repeat cesarean. Besides which, if things with my health or the baby's were in such a bad way that an induction would be worthwhile, I don't think the stress of drugs would be a good thing.

But it would still be an agonizing decision.
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#16 of 25 Old 12-18-2006, 12:29 PM
 
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I had Pitocin to augment my VBA2C, so I'm not sure about it, honestly. I know that the risk can be increased, but if it is done properly it's a risk I can be comfortable with. So, it depends. If I was 42w 1d and showed very favorably for an induction--some ctx on my own, soft, dialating/effacing cervix, what have you--then I'd go for the induction. But if there weren't very friendly signs for induction, then I'd opt for the c-section, because in the end that's how it would wind up.

Sabra: Mama to Bobbie (3/02), Linda (1/04), Esther (10/05), Marie (11/10), & Douglas (11/12)

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#17 of 25 Old 12-18-2006, 03:06 PM - Thread Starter
 
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Sabra, I think we have similar thought patterns on this topic. I think there's a major difference between being induced w/o being favorable (probably needs a LOT more pitocin to get you started, and turns into a much more difficult labour) and giving labour just a bit of a boost if one is already having some contractions and everything looks favorable (though by that point I suppose labour would likely be starting on its own at any point). If it came to an ultimatum, and my situation was the latter I'm fairly sure I'd go for the induction.

I'd be interested on hearing what a medical professional would think regarding the topic - whether the latter is equally dangerous.

Also, does anyone have any statistics regarding the correlation of different types of inductions to UR? I've heard that using prostagladins is the most hazardous form of induction... but I have no idea what the difference is between that and pitocin, in terms of UR.

Also (this is my last Also, I promise), EPO creates prostaglandins right? I'm planning on starting a strict EPO regimen around 35 or 36 weeks, both orally & vaginally, but I want to make sure that this isn't considered a "prostaglandin induction" even though it's very mild and "natural". Any thoughts?
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#18 of 25 Old 12-18-2006, 03:31 PM
 
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Heyla!

For studies and stats, check out the sites I mentioned above. One study that looks at the variable rupture rate with different methods is:

Uterine Rupture During Induced Trials Of Labour In Women With A Previous Cesarean Delivery from the American Journal of Obstetrics and Gynecology, January 2000

Here's part of the results section... (the table formating is all messed up...sorry the original is available on the site in my previous message.)

Quote:
Between 1992 and 1998, there were 2119 TOL, 575 of which were induced (27%). The overall rate of uterine rupture was 15/2119 (0.71%). The uterine rupture rate with induced TOL (8/575, 1.4%) was significantly higher than with spontaneous TOL (7/1544, 0.45%), p=0.036. The relative risk of uterine rupture with induction was 3.09 (95% CI 1.12 to 8.42). Uterine rupture rates by method of induction (alone or in combination with another) are shown in the table below and are compared with uterine rupture during spontaneous TOL.

Method/ Number of Ruptures/ Number of women/ Rupture rate
PGE2/ 5/ 172/ 2.9%

Method/ Number of Ruptures/ Number of women/ Rupture rate
ARM/ 2/ 130/ 1.5%

Method/ Number of Ruptures/ Number of women/ Rupture rate
Foley/ 1/ 130/ 0.76%

Method/ Number of Ruptures/ Number of women/ Rupture rate
Oxytocin/ 5/ 427/ 1.2%

Method/ Number of Ruptures/ Number of women/ Rupture rate
Spontaneous TOL/ 7/ 1544/ 0.45%

The relative risk of uterine rupture with PGE2 use versus spontaneous TOL was 6.41 (95% CI 2.06 - 19.98). The relative risk for Foley catheter induction compared with spontaneous TOL was 1.70 (95% CI 0.21 to 13.69).


PGE2 is a prostaglandin, ARM is artificial rupture of membranes, Foley is the "balloon" manual induction, Oxytocin and Spontaneous TOL are...well...oxytocin and naturally beginning labor

And the VBAC site I mentioned is very comprehensive (google Vbac and Turk if the link doesn't work...it'll be the first hit)...the site pulls together literally hundred of VBAC and VBAC related studies and provides a quick summary of the findings. Although you do need to browse through the site manually since it doesn't have a great search feature.

A few summaries I pulled out during a really quick browse of the first page:

Quote:
Found that women treated with prostaglandins tend to rupture at the location of the previous scar more frequently than women in the oxytocin group whose rupture tended to occur remote from their old scar.
from a study at Yale, published in BJOG vol112 pg38 2005

And

Quote:
Induction was more frequent in the uterine rupture group and they were much more likely to have had cervical ripening. The odds ratio for cervical ripening and uterine rupture was 3.93. The risk/benefit ratio would seem to discourage cervical ripening.
from a study by Hoffman, published in OGS vol60 pg22 2005

Hope this helps!

I guess my question from before is "why do you need to be induced at 42 weeks?". I started labor naturally with dd and that wasn't until after 42 weeks. My doctor never mentioned induction, though they did ask me to keep an eye on fetal movements and let them know if they seemed to slow down. If there is a medical need to induce then I'd go for it since it could end with a VBAC. But if it's just a matter of office "policy" then I just wouldn't show up at the hospital for a scheduled induction.

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#19 of 25 Old 12-18-2006, 03:53 PM - Thread Starter
 
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WOW thanks so much! I really have to find the time to read all the info that you posted earlier... I'm just so busy normally that it's impossible! So thank you, thank you for posting that! How interesting, eh?

I'm definitely going to have to ask my doctor about a foley cath. if the time comes. I totally kwym though... if I'm totally favorable at 42 weeks, I would be very inclined to think labour is coming naturally very soon anyway. It IS my body, and I most certainly won't be doing anything this time simply because it's "policy". I'll have to carefully balance the pros and cons when the time comes
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#20 of 25 Old 12-18-2006, 10:08 PM
 
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Hands down a repeat csection than an induction with pit.
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#21 of 25 Old 12-18-2006, 10:45 PM
 
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You and I must have the same OB, lol! They're letting me go to 42 weeks before wanting to induce. I don't care, as long as everything is fine with me and baby, I'm not going to the hospital to be induced. I was induced with my son and it ended in an emergency c/s... so I don't want to go down that road again. I know when I O'ed this time, so my due date is correct, so I'm sure I won't go to 42 weeks. But it's good knowing that my OB will allow me to go to 42 weeks before trying to talk me into inducing. Anyway, if I were you... I'd go with what you feel comfortable with.

Me Hubby
Colin 1/13/04 Elena 1/18/07
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#22 of 25 Old 12-19-2006, 09:30 AM
 
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i just went through this exact situation in april. i'm glad to see lots of others would have made the same decision, i have been dwelling on it ever since. you know, the "what ifs"...

i went to 43 weeks and my midwife dropped me. i had taken castor oil (two bottles, nasty stuff!!!!!), the cohoshes, epo, stripping membranes, etc etc etc, everything to try to induce so i could get by hbac.

it didn't work, so i got referred to an ob who had a vbac wife, so he was compassionate, and asked if i would like to try pit and i said no, i'd feel more comfortable with a repeat section.

the recovery was a lot easier this time around, but next time i'm going to try homebirth again. 3rd time lucky i hope!
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#23 of 25 Old 12-19-2006, 04:16 PM
 
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I just changed midwives and this practice does not induce VBACs at all so it doesn't look like I'd have that choice. So I think pretty much the bottom line is that they'd want to schedule me for a c-section at 41 weeks, but she sugar coated that a little bit and said instead that she trusted that my body would do it's thing before then and we wouldn't have to worry about it.Anyhow, my son came 2 days before the earliest due date we had (I had 3 different estimates, LMP, early u/s, and 20 wk u/s), so I am not going to worry about it either...

Minta
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#24 of 25 Old 12-19-2006, 05:48 PM
 
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Originally Posted by crunchykd View Post
All that said, I had a low dose Pitocin with my last VBAC to augment labor. It was that or c-section. I'm so, so glad that I chose the Pit. I had an awesome VBAC that I wouldn't trade for the world. The statistics ARE greater that you could rupture with Pit but it's not really that much. My OB was very careful not to give me much and it worked enough to keep my c-section away.
I had the exact same situation and had a successful hospital vbac with no complications at all. I would chose a induction over another c-section anyday. My ob was the exact same way as the previous posters and gave me a very very low dose of Pitocin.

My first c-section was a planned c-section so I was never induced and maybe that's why I feel the way I do.
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#25 of 25 Old 12-20-2006, 03:26 PM
 
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Quote:
Originally Posted by mum2James&Bean View Post
Also (this is my last Also, I promise), EPO creates prostaglandins right? I'm planning on starting a strict EPO regimen around 35 or 36 weeks, both orally & vaginally, but I want to make sure that this isn't considered a "prostaglandin induction" even though it's very mild and "natural". Any thoughts?
EPO is not considered an induction. EPO only contains the precursors to prostaglandins. It will soften and ripen your cervix, but will not cause any contractions.

The prostaglandins PGE1 (misoprostol or Cytotec) and PGE2 (Cervidil or Prepidil) are actual prostaglandins and may cause contractions and even uterine hyperstimulation. Cytotec shows very clear evidence of causing uterine rupture, even in non-VBAC cases. Cervidil is safer (it can be usually be removed because it can come in a tampon like form, unlike Cytotec which cannot be removed), but still risky.
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