Induction more dangerous for vbac?

[Mom2Connor]

I want to preface that I love my OB so please no suggestions of going elsewhere. I had an emergency c section at 38 1/2 wks with DS (only 10 days early). It was due to pre-e /HELLP syndrome. My doc was not on call, it was another doc from the practice that I had never met. At the time it was presented as sign here, you need a caection now. I signed and it went well so no complaints.

I would like to try for a vbac and my doc is supportive of that. She did mention yesterday that it's best to go into natural labor. The pre-e may be trying to crop up again. So if it hits at,say, 38 wks she said induction if my body is no where near ready can cause an enhanced risk of rupture (15%) as opposed to a very tiny chance otherwise. Yes I know a c sec is a controlled rupture.

My concern is that at 38.5 wks with DS my cervix was still said to be long and closed, or hard and closed? Not ripe for birth. What are the chances the second will be different?

[s@hmommy]

Every pregnancy is different. I had dd at 39 wks and 5 days and ds just at 37 weeks. My mom had my 3 siblings at 38 weeks and me at 42 weeks. Don't get discouraged until it happens, maybe this time you will get lucky and have no issues!

[BeccaSueCongdon]

The thing your provider is likely concerned about is the fact that prostaglandins (the stuff they use to ripen a cervix before and induction) is shown to greatly increase the risk of rupture. Conservative uses of pitocin can be used safely under monitoring, which could be an option. And if your cervix is open even just 1cm, they may be able to dilate you with a Foley catheter. Those are options to discuss with your provider, and foley Catheter hasn't been shown to significantly increase the risk of rupture.

Hopefully you won't have to deal with that, though! Some women end up having their cervix getting "ready" sooner with subsequent pregnancies.

[ankc]

I'm surprised they would induce with a prev c-sect. I thought that was a big no no... I tried for a vbac with ds2 and my midwifes and ob said no pitocin for induction and i was not even able to get an epidural. never ended up having success with the vbac but glad i was not given pitocin. GL and keep researching

[birdinhand]

Originally Posted by BeccaSueCongdon The thing your provider is likely concerned about is the fact that prostaglandins (the stuff they use to ripen a cervix before and induction) is shown to greatly increase the risk of rupture. Conservative uses of pitocin can be used safely under monitoring, which could be an option. And if your cervix is open even just 1cm, they may be able to dilate you with a Foley catheter. Those are options to discuss with your provider, and foley Catheter hasn't been shown to significantly increase the risk of rupture. Hopefully you won't have to deal with that, though! Some women end up having their cervix getting "ready" sooner with subsequent pregnancies.

I agree. Ask about a foley cath option, if your cervix is favorable. Personally, and I know this is just my opinion, I would go for an induction with a supportive care provider for a TOLAC (trial of labor after cesarean) in the hospital before just signing that paper again and going for an automatic cesarean.

Have you looked at using evening primrose oil to help with cervical ripening? I must state, I have not looked at whether EPO is contraindicated for VBAC. And sex, of course.

[canadianbakers]

Originally Posted by ankc I'm surprised they would induce with a prev c-sect. I thought that was a big no no... I tried for a vbac with ds2 and my midwifes and ob said no pitocin for induction and i was not even able to get an epidural. never ended up having success with the vbac but glad i was not given pitocin. GL and keep researching

You were given wrong info, unfortunately.
Pitocin is actually the recommended method for VBAC induction, and epidurals are definitely allowed!

Here's the SOCG guidelines for VBAC - it's kinda a boring read, but well worth having "under your belt" when talking with your OB/MW about VBACs.
The only trouble is that these are the guidelines in Canada... so they may argue with you about being in the states... I would argue that our bodies can't be that different, and ask them what makes a uterus magically change when we cross the border!!!

As far an inductions for VBACs go, cytotec is contraindicated completely - so I wouldn't even let that be an option given to me.
Cervidil is not recommended either - the thing is, that med works to thin the cervix, but the cervix is just the bottom/neck of the uterus and while thinning there, it can cause thinning of the lower portions of the uterus as well. Obviously this would increase the risk of rupture.
Pitocin is recommended as a form of induction, though they recommend constant fetal monitoring along with the pit.
And, AROM is fine.

This was actually my plan for induction (that I gave my OB, lol, but he completely agreed with me) - I would allow my body to go to 42 weeks, but DH and I were not comfortable with the risks of going beyond that point. At 42 weeks, if labor had not occurred naturally, we would start with AROM (because at that point I wouldn't care about being "on the clock", as I would want baby delivered whether by VBAC or csec) and see what my body did. If labor started, great. If not, we would start pit and see how things went.
Thankfully, this wasn't necessary as labor began on its own. But it was my plan, and like I said, my OB fully agreed with me.

[mibarra]

Originally Posted by BeccaSueCongdon The thing your provider is likely concerned about is the fact that prostaglandins (the stuff they use to ripen a cervix before and induction) is shown to greatly increase the risk of rupture. Conservative uses of pitocin can be used safely under monitoring, which could be an option. And if your cervix is open even just 1cm, they may be able to dilate you with a Foley catheter. Those are options to discuss with your provider, and foley Catheter hasn't been shown to significantly increase the risk of rupture. Hopefully you won't have to deal with that, though! Some women end up having their cervix getting "ready" sooner with subsequent pregnancies.

This is my understanding as well. I had a VBAC with an epidural and small amount of pitocin. Also, if you're starting to dilate at all there's also stripping your membranes, which can help induce labor sometimes as well.

But every pregnancy is different, so I hope this goes more smoothly!!

[Mom2Connor]

Thanks for the advice! That makes total sense about the stuff used to ripen the cervix. She did say if I was dilated a few cm there was a chance induction would be successful and safer. So it sounds like pitocin would be an option as long as my cervix shows signs of cooperation?

[Mom2Connor]

Originally Posted by birdinhand I agree. Ask about a foley cath option, if your cervix is favorable. Personally, and I know this is just my opinion, I would go for an induction with a supportive care provider for a TOLAC (trial of labor after cesarean) in the hospital before just signing that paper again and going for an automatic cesarean. Have you looked at using evening primrose oil to help with cervical ripening? I must state, I have not looked at whether EPO is contraindicated for VBAC. And sex, of course.

I have never heard of EPO, i can talk to my doc about it...how and at what point is it used?

[jj7202]

I have heard that even ingesting semen will help with the ripening hormones as an alternative, if sex is to uncomfortable... And I just read this article about eating dates and its affects on ripening...

http://www.ncbi.nlm.nih.gov/m/pubmed/21280989/