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#11
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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 |
#12
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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. |
#13
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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. |
#14
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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 |
#15
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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 |
#16
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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 |
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