At what point do you induce vs going repeat c/s? - Mothering Forums

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#1 of 28 Old 09-10-2008, 06:35 PM - Thread Starter
 
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I had a c/s with my first, a VBAC with my second. I went four days over with her.

My OB (the same that I delivered with for my first) made me schedule an induction today. She's not comfortable with me going past my due date at all. I'll be four days over due for the induction. I'm pissed. Last time it was not this way at all and really feel like it's a money and control issue from their office.

I know that I could just not show up.

I guess what I'm wondering is as fellow VBACers at what point do you go with an induction over a repeat c/s?

I am 2-3cm dilated. I know a lot of the natural methods - sex, walking, EPO, nipple stimulation (still nursing my 25 month old - that counts, right?). I've heard bad things about cohashes, so not sure I want to go that route. Of course, it sounds better than pit!
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#2 of 28 Old 09-10-2008, 06:38 PM
 
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That is a really, really, profoundly bad idea IMO. The risks of uterine rupture get much higher if you induce a VBAC I think. Going past due on the other hand, has little risk. I would schedule a c before I'd be induced VBAC personally.

However, I don't have links because I did research last year before my VBAC and didn't keep any of them. So hopefully someone else can give you some links to print out for the OB.

Here's this, which I found quickly by googling "induce VBAC uterine rupture" http://www.homebirth.org.uk/vbacur.htm I'm sure there's a lot more.

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#3 of 28 Old 09-10-2008, 07:11 PM
 
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I would ask to reschedule and if your OB won't, I would consider not showing up. The induction alone puts you at higher risk for a c/s, which is what you want to avoid. Follow your heart and do what you know is best!
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#4 of 28 Old 09-10-2008, 07:56 PM
 
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At my last appointment, I asked my OB if the use of pitocin had anything to do with increased uterine rupture and not only did he say "yes," but that artificially augmenting vbac labor went against some sort of standard of care.

So that when they *did* support VBAC (which they don't now), they weren't using anything ever.

I don't think he's fibbing; I do think that some OBs are not as careful as they should be.

So yeah, avoid induction.

Mom of two girls.
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#5 of 28 Old 09-10-2008, 09:00 PM
 
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I'm planning a VBAC too and my OB also said that she would not induce me because it increases the risk of uterine rupture so to answer your question, no I would not get induced.
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#6 of 28 Old 09-10-2008, 09:07 PM
 
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And four days overdue is such an arbitrary number! If your date of conception is off by a bit, four days overdue could actually be 7 days early!! It sounds like your dr is trigger happy! Why is going overdue (and by so little) such a big deal? I don't get it.

Mama of 2 sweet boys, Miles (Jan 3/07) and Avery (Nov 28/09) My fast and furious HBAC
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#7 of 28 Old 09-10-2008, 10:55 PM
 
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I would not induce, except possibly using a Foley cath if my CP would do it that way. Induction using prostaglandins is contraindicated for VBAC. Some OBs will use pit on a VBAC in carefully controlled conditions, usually to augment rather than induce. But you have to be very careful with it, and I wonder why your OB is talking induction at all.

Personally I would not rush to have a repeat. There is some evidence that outcomes for VBAC are worse after 41 weeks, but I certainly wouldn't consider ERCS before that point (absent medical indication, obviously!) and I would probably go closer to 42 weeks (with monitoring at 41).

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#8 of 28 Old 09-10-2008, 11:18 PM
 
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This makes no sense to me. The risks of going 'overdue' are not comparable to the risks of inducing a Mama with a previous c-section.

It's pretty clear that inductions increase the risk of uterine rupture. Once source - From the guidelines provided by Society of Obstetricians and Gynaecologists of Canada (sorry this is the source I am most familiar with)


Quote:
8.Oxytocin augmentation is not contraindicated in women undergoinga TOL after Caesarean section (II-2A).

9. Medical induction of labour with oxytocin may be associated with an increased risk of uterine rupture and should be used carefully after appropriate counselling (II-2B).

10. Medical induction of labour with prostaglandin E2 (dinoprostone)is associated with an increased risk of uterine rupture and shouldnot be used except in rare circumstances and after appropriatecounselling (II-2B).

11. Prostaglandin E1 (misoprostol) is associated with a high risk ofuterine rupture and should not be used as part of a TOL afterCaesarean section (II-2A

http://72.14.205.104/custom?q=cache:...google-coop-np
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#9 of 28 Old 09-11-2008, 12:17 AM
 
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I just experienced this a month ago...I was two weeks overdue, 3cm dilated, 80% effaced. My OB would not induce under any circumstances (I pretty much begged...) and so gave into the repeat c. He told me that I had maxed out my time and it was just not safe to induce.
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#10 of 28 Old 09-11-2008, 01:45 AM
 
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My OB (the same that I delivered with for my first) made me schedule an induction today.
And the cool thing about being the Mama is that you can make her unschedule it if you want. She cannot force you to do something you do not want to do. Period.

If you do not want to be induced or if you do not want a c/s....then simply do not consent to them. It may tick your OB off to no end but so what...the choice is yours and not hers. She can get mad, throw a fit, toss out the dead baby card...but she cannot drop you from care nor can she make you do something you do not consent to.

While studies show that going postdate is not that big of a deal...studies also show that inducing a VBAC does raise the risk of UR. IMO, your OB is acting *very* irresponsibly.

This birthing choice is yours...she can't take that power away from you...only you can give it away.

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#11 of 28 Old 09-11-2008, 01:58 AM
 
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For some reason, not all OBs have gotten the "DO NOT INDUCE VBACs" memo. It is shown to increase the rate of rupture, and all the other negative things we hear about pit, cytotec, cervadil do not go away just because they want it to. What I have found to be the case sometimes, is they use the word "induce" when that's not really what they do. It seems to be becoming the trend (at least around here) for OBs to schedule "inductions" on VBAC moms, and really just break their water and start them on a time clock. Did you clarify what your OB meant by an induction? I'm not saying I'd go for the breaking of the waters either by any means. Just saying that is something that is done around here. I don't get why going just a few days past your due date is such a big deal anyway. Its not like you are pushing 42 weeks or anything. Four days is no big deal! That could just be you ovulating a tad later than "normal". Bottom line is you don't have to make this choice between induction and repeat c/s. If there is no medical reason for the induction, I would personally wait it out. You can request a NST if you feel the need to give the OB some sort of reassurance your baby is fine. But no, knowing the risks of an induction with a VBAC, I would not agree to be induced with any sort of artificial anything. Your baby will come when it is time, not when your OB says so!
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#12 of 28 Old 09-11-2008, 01:00 PM
 
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I wouldn't do it at all. I VBAC'd twins at 38 weeks and I measured at LEAST 45-46 weeks pregnant. So if your doctor is trying to argue uterine size, that doesn't really fly by my book. If the stupid resident had had her way she would have broken my water at 35 weeks! I don't know what the hell the deal is with OBs and inductions. Leave well enough alone unless you have evidence there is a problem!

Repeat after me, "No. I am not comfortable with an induction and I will not schedule one nor will I discuss it prior to 42 weeks." It's so hard to say no sometimes. It was one of my really tough lessons to learn with my VBAC. "No. No thanks! No!" Then they get that look on their face like "What? Did she just tell me no?"

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#13 of 28 Old 09-11-2008, 01:57 PM
 
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Originally Posted by lisa_nc View Post
Then they get that look on their face like "What? Did she just tell me no?"
:::

OMGosh....that's so true!!! They usually don't know how to respond at first. Priceless.

- Kim
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#14 of 28 Old 09-11-2008, 03:04 PM
 
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Unless you mean you are over 42 weeks, you are not overdue! The NORMAL average pregnancy is 38-42 weeks. So 40 weeks is your estimated due date. But you are not out of the average range until 43 weeks.

ACOG clearly states that going 42 weeks does not increase VBAC risk. Induction does. So unless you have a specific medical issue to consider, I wouldn't induce. Same with a c-section. Why take the risks unless there is a documented medical reason to do that!?

Plus, you are already dilating, so you know your body is already taking steps for this birth. Trust that!

I took castor oil to start my vbac labor because I was getting really stressed by the pressure from my doctors. It's not as risky as the cohashes, and you can more easily control the dose. This time around I will wait and let my body do what it knows how to do. Yours does too!
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#15 of 28 Old 09-11-2008, 03:37 PM
 
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I might go for a foley induction if I was already 42 weeks, or if there was a clear medical indication the baby needed to get out very soon (such as very high blood pressure), but I probably wouldn't agree to pitocin as a first-choice method of starting contractions. I doubt I'd go for an elective induction at just 40 weeks.

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mama to T, 5; L, 2; and EDD 12/20/08
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#16 of 28 Old 09-11-2008, 05:01 PM
 
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Great thread. I am a day or two past my due date and have an appt with the one OB that is not as VBAC friendly. I'm wondering how it will go, and whether the induction conversation will happen. Good to be reminded that I can say "no".
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#17 of 28 Old 09-11-2008, 05:10 PM
 
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My OB told me from day one that I am "not inducible" since I had a previous c-section. She will let me get to 42 weeks and then it's automatic c-section. Personally, I would not show up for an induction 4 days past my due date. That's ridiculous.
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#18 of 28 Old 09-11-2008, 05:28 PM - Thread Starter
 
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Originally Posted by rachaelmomma View Post
For some reason, not all OBs have gotten the "DO NOT INDUCE VBACs" memo. It is shown to increase the rate of rupture, and all the other negative things we hear about pit, cytotec, cervadil do not go away just because they want it to. What I have found to be the case sometimes, is they use the word "induce" when that's not really what they do. It seems to be becoming the trend (at least around here) for OBs to schedule "inductions" on VBAC moms, and really just break their water and start them on a time clock. Did you clarify what your OB meant by an induction? I'm not saying I'd go for the breaking of the waters either by any means. Just saying that is something that is done around here. I don't get why going just a few days past your due date is such a big deal anyway. Its not like you are pushing 42 weeks or anything. Four days is no big deal! That could just be you ovulating a tad later than "normal". Bottom line is you don't have to make this choice between induction and repeat c/s. If there is no medical reason for the induction, I would personally wait it out. You can request a NST if you feel the need to give the OB some sort of reassurance your baby is fine. But no, knowing the risks of an induction with a VBAC, I would not agree to be induced with any sort of artificial anything. Your baby will come when it is time, not when your OB says so!

The induction paper work clearly says pitocin on it. Oh, and bed rest after water is ruptured (gag me).

I did have a VBAC with my last baby and went over with her by four days - I am seriously considering just calling and canceling on Tuesday night/Wednesday morning. I imagine that might elicit a phone call from the OBs office?

I'm great at defending other people, but can be a bit of a wuss when it comes to defending myself. I admit, I get pissed off and just start crying.
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#19 of 28 Old 09-11-2008, 06:45 PM
 
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Just tell them you can't get childcare for that day or something & you'll get back to them.

mom to all boys B: 08/01ribboncesarean.gif,  C: 07/05 uc.jpg, N: 03/09 uc.jpg, M: 01/12 uc.jpg and far too many lost onesintactlact.gifsaynovax.gif

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#20 of 28 Old 09-11-2008, 06:51 PM
 
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Originally Posted by Devaskyla View Post
Just tell them you can't get childcare for that day or something & you'll get back to them.
:

FWIW I was induced with my first vbac via foley + pit. However, at that time they really didn't know any better (1995) and I was at 42w+6d.

I really like the idea of calling up and saying you can't get childcare for that day and you'll get back with them as soon as you get something lined up. And then don't get anything lined up until you go into labor!
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#21 of 28 Old 09-12-2008, 09:52 PM
 
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I would never schedule a repeat c/s without trying to induce first (and never ever w/ prostaglandins). My VBAC was 9 days past EDD and we were going to let it go to 42 wks unless an NST had nonreassuring results. Personally, I'm ok w/ the risks of VBAC induction (foley, break membranes, and gentle pit if necessary) IF there is a good medical reason to get the kid out. I'd try everything natural to get labor going on my own first tho.

Mom to James (ribboncesarean.gif 5/2006), Claire (vbac.gif 6/2008), furry kitties Calvin and Bob, and wife to Dennis. 

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#22 of 28 Old 09-14-2008, 08:40 PM
 
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I'm w/ Karen, I would induce before agreeing to a c/s. I had pitocin w/ my last VBAC and probably will this time as well, as un-MDC as it is. I was 'induced' or 'augmented', however you want to look at, w/ my last baby at 39 wks. They started the pit at 10:30, broke my water at 12:30 and she was born at 2:04. All is well.

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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#23 of 28 Old 09-16-2008, 02:59 PM - Thread Starter
 
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Just thought that I would stop by and update.

My water ended up breaking on Friday morning, 9/12. I did everything I could to get some contractions going (I'd been having them all night Thursday until Friday morning when DD woke up). Nothing worked. DD nursing, walking, scrubbing floors, rest, castor oil....

So, Saturday morning, we headed to the hospital. We had our doula with us. We ended up getting pitocin around 1? It took them a few tries to get the IV in, so that was a few more hours of no contractions. I know some here would have just waited it out, but we were past our comfort level - we've lost one newborn baby and well - we were just at that limit.

Anyways, it was pretty slow going until around the time I hit 6 cms - which must have been around 9 pm. In twenty minutes I was at an 8 and begging for drugs - OMG, did it hurt at that point. I couldn't get on top of the contractions as they were just too close together - could be because the pitocin was still on or maybe that's just how it feels at that point. In any regard, when the nurse told me I was just an 8 I wanted some drugs and started asking for them - I thought, crap a cm an hour? I'll never make it another two hours like this is all I could think of. It took 10 minutes to actually go from 8 cm to baby out. During which time the Dr was called and my doula convinced the nurse to turn down the pit a bit. And then she gave me the shot of nubain and before she was even done putting it in the IV, I was feeling like I had to poop - so then a few pushes later and DS arrived. The Dr didn't make it, so they called the house Dr who rushed in from watching the OSU game to finish catching the baby. I was on my side, but he flipped me to my back (which is when I had some tearing). They didn't even get to break down the table, everything just happened so quickly at that point.

I think I have most of my times right - I'll have to check with my doula as she was keeping track of things.

I do know that although everyone tells me that it was natural as there wasn't time to even get it in and working before the baby was out, I know I would have asked for something stronger than that even, way, way earlier if it hadn't been for my great doula. Doulas rock! :

This was my second VBAC, though last time was with an epi and only a touch of pitocin to bring the contractions closer together when they spaced after the epi was placed.
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#24 of 28 Old 09-16-2008, 05:03 PM
 
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Congrats!!! :::

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I survived 16 mos! Ask me about breastfeeding a baby with posterior tongue tie, high palate, and weak oral motor skills- whew!

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#25 of 28 Old 09-16-2008, 05:19 PM
 
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Congratulations! :

mom to all boys B: 08/01ribboncesarean.gif,  C: 07/05 uc.jpg, N: 03/09 uc.jpg, M: 01/12 uc.jpg and far too many lost onesintactlact.gifsaynovax.gif

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#26 of 28 Old 09-16-2008, 07:02 PM
 
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Yay Momma!! Congratulations!! :

treehugger.gifAnd you who seek to know Me, know that the seeking and yearning will avail you not, unless you know the Mystery: for if that which you seek, you find not within yourself, you will never find it without.treehugger.gif

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#27 of 28 Old 09-16-2008, 07:46 PM
 
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Congrats!

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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#28 of 28 Old 09-16-2008, 10:34 PM
 
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Congratulations! And welcome to the World, Little One!

Mama to two awesome kids. Wife to a wonderful, attached, loving husband. I love my job-- I'm a Midwife, Doula and Childbirth Educator, Classes forming now!

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