Elfanie wrote:

**** however...an even more recent and larger study showed that
inducing with pitocin DOES increase the risk....however, even the
elevated level of risk is very very low.. *****

A large 2004 study of VBACS found a statistically
significant increase in rupture risk for both oxytocin
augmentation (odds ratio 2.42) and oxytocin induction
(odds ration 3.01). Use of oxytocin brought the risk
of rupture up to around 1 percent, which *personally*
I don't consider insignificant in size. Interestingly,
the same study *didn't* find prostaglandins *alone*
to be as risky, with no ruptures in the prostaglandins
alone group (of 227 women). Induction using both
oxytocin and prostaglandins was riskier than either
alone. I think this one is one of the better studies.
Many others are heavily confounded, and oxytocin
induction/augmentation is *so* pervasive that it is
frequently just taken for granted and not factored
into analyses.
It seems clear to me based on this and several other
studies that it is best to avoid induction or augmentation
with a VBAC if at all possible. The rub comes in when
there's a real need to get the baby out and it's either
induction/augmentation or an automatic c-section.

Obviously, you can never consider any particular
risk in isolation. You always have to consider the bigger
picture. If you get to the point where everyone agrees
it's down to ERCS or induce VBAC, then you have to consider:

1) The risk that you will end up with an emergency c-section
anyway, thus accepting the risks of BOTH the VBAC attempt
AND the c-section (which risk obviously depends partly
on the reason *why* the immediate delivery is necessary)
2) The risks of the c-section to the mother.
3) The risks of the c-section to the baby
4) The risks of the c-section to future babies, if there are
to be any

One also has to consider the severity of the various risks,
of course.

How the final assessment works out is going to
depend heavily on the individual situation. I do think
there's a point where the odds of a successful VBAC are
low enough and the risks of augmentation high enough
that many people will come to the conclusion that in
their situation, the ERCS is preferable.

Best wishes,
Ericka

It's not that I want to be induced it's if they feel that the labour
isn't progressing and they would under normal circumstanceds induce, to
help the delivery/lobour along.

chris wrote:
Has anyone been induced in a second pregnancy after having a c-section
the firsttime around? It's been 3 1/2 years since my c-section but my
doctor will not induce me for fear of the scar rupturing and creating
an emergency c-section. Now she will let me go a normal vaginal birth
but just will not induce me.

I had a VBAC in April that was pushed along with pitocin. My water had
broken, but I wasn't having strong enough contractions. My doctor had
told me a week earlier that they won't induce VBACs, but I guess this
wasn't considered an induction, since I was already in labor. I did
have to sign a statement that said that I agreed to a c-section if
things didn't go well, surgery if my my c-section incision ruptered, or
a hysterectomy if they had to do surgery on a ruptered uterus and it
didn't work. I didn't need any of those, thank goodness.

chris wrote:

It's not that I want to be induced it's if they feel that the labour
isn't progressing and they would under normal circumstanceds induce, to
help the delivery/lobour along.

Are you talking about induction or augmentation? Induction
is *starting* labor when it won't start. Augmentation is artificially
strengthening contractions when labor has started but isn't
progressing adequately. Pitocin/oxytocin can be used for either.
Frankly, induction and augmentation are both done *far*
more often than they're really necessary, and they do have risks,
so the first question should always be whether they're truly
necessary. Only after that is there a question of how safe it
is during a VBAC.

Best wishes,
Ericka

chris writes:
: Has anyone been induced in a second pregnancy after having a c-section
: the firsttime around? It's been 3 1/2 years since my c-section but my
: doctor will not induce me for fear of the scar rupturing and creating
: an emergency c-section. Now she will let me go a normal vaginal birth
: but just will not induce me.

Yes. There are very good reasons for this. Do you think it is a
problem. Why are you posting the comment. You doctor is very wise.

Larry

In message . com, chris
writes
Has anyone been induced in a second pregnancy after having a c-section
the firsttime around? It's been 3 1/2 years since my c-section but my
doctor will not induce me for fear of the scar rupturing and creating
an emergency c-section. Now she will let me go a normal vaginal birth
but just will not induce me.


I had a c-section first time round too. I saw the obstetrician a couple
of weeks ago. What he said was that if I get to 40 wks without having
delivered, they would want either:

(a) another section, or

(b) to induce. They would not use prostins, but instead would use a
balloon catheter thingy to press down on the cervix, mimicking the
baby's head.... and then would start the syntocinon drip.

******** to both of those, I say.
--
Mogget