VBAC and induction

My midwife kind of threw me for a loop at my last appointment. I'm due
tomorrow (July 24) and have no signs of impending labor. I'm trying
for a VBAC (DD's c-section was over 3 years ago). So on Wed, I was
talking to the midwife and we were discussing what the next two
weeks brings. An ultrasound at 41 weeks to make sure things are
going well, and then she asked me how I felt about induction. I
was surprised, thinking they wouldn't induce a VBAC. She said they
wouldn't do the cervix ripening gels, but would do a low dose
pitocin. Any thoughts? I'm going to do some digging in the literature,
although I have time since we are talking at the earliest 41 weeks
and they'll let me go to 42 if everything is OK with baby (although
I'm not sure I can stand this for another 2 weeks!).

My blood pressure was a bit high at the last appointment, but
came down when I layed down for a bit. That may be what
prompted her comment about inducing.

She also told us to have lots of sex and go to a local
restaurant and get their eggplant parmisan, guarenteed to
put you in labor!

Mary

"Mary W." wrote in message
...
... and then she asked me how I felt about induction. I
was surprised, thinking they wouldn't induce a VBAC. She said they
wouldn't do the cervix ripening gels, but would do a low dose
pitocin. Any thoughts? I'm going to do some digging in the literature,
although I have time since we are talking at the earliest 41 weeks
and they'll let me go to 42 if everything is OK with baby (although
I'm not sure I can stand this for another 2 weeks!).

The question that springs instantly to my mind is this: what happens if the
"low dose of pitocin" doesn't work? Do they turn it up? Keep turning it up?
Break your water, wait an hour or two and if you don't go magically into
labor, tell you you must have a cesarean? These are important questions.
Because what if the "induction" fails? What steps will they want to take?

--angela

Chotii wrote:

"Mary W." wrote in message
...
... and then she asked me how I felt about induction. I
was surprised, thinking they wouldn't induce a VBAC. She said they
wouldn't do the cervix ripening gels, but would do a low dose
pitocin. Any thoughts? I'm going to do some digging in the literature,
although I have time since we are talking at the earliest 41 weeks
and they'll let me go to 42 if everything is OK with baby (although
I'm not sure I can stand this for another 2 weeks!).

The question that springs instantly to my mind is this: what happens if the
"low dose of pitocin" doesn't work? Do they turn it up? Keep turning it up?
Break your water, wait an hour or two and if you don't go magically into
labor, tell you you must have a cesarean? These are important questions.
Because what if the "induction" fails? What steps will they want to take?


Really good questions. I'm thinking that if I agree to an induction we are
at the no turning around point (for whatever reason, 42 weeks, high
BP, whatever) and the only other option is an ERC. So if we get to the
point where the decision has been made that baby is better off on the
outside than the inside, do I consent to an ERC, or do I try the low
dose pitocin and see what happens? And yes, where do I draw the
line - how much intervention to I risk (with the associated rupture
risks) before consenting to the c-section.

So I guess it boils down to the risks of inducing a VBAC (pitocin/
breaking water, etc) vs. the risks of an ERC.

Hopefully we wont come to this, but I want to have it clear in my
mind what I want to do if we reach the point where baby needs
be out.

Thanks Angela!
Mary

"Mary W." wrote:

My midwife kind of threw me for a loop at my last appointment. I'm due
tomorrow (July 24) and have no signs of impending labor. I'm trying
for a VBAC (DD's c-section was over 3 years ago). So on Wed, I was
talking to the midwife and we were discussing what the next two
weeks brings. An ultrasound at 41 weeks to make sure things are
going well, and then she asked me how I felt about induction. I
was surprised, thinking they wouldn't induce a VBAC. She said they

Did a little digging and found this article by Henci Goer:

http://www.parentsplace.com/pregnanc...4115-1,00.html

Sheds some light on the subject and I thought fellow VBACers might
find it useful.

Mary

My midwife kind of threw me for a loop at my last appointment. I'm due
tomorrow (July 24) and have no signs of impending labor. I'm trying
for a VBAC (DD's c-section was over 3 years ago). So on Wed, I was
talking to the midwife and we were discussing what the next two
weeks brings. An ultrasound at 41 weeks to make sure things are
going well, and then she asked me how I felt about induction. I
was surprised, thinking they wouldn't induce a VBAC. She said they
wouldn't do the cervix ripening gels, but would do a low dose
pitocin. Any thoughts? I'm going to do some digging in the literature,
although I have time since we are talking at the earliest 41 weeks
and they'll let me go to 42 if everything is OK with baby (although
I'm not sure I can stand this for another 2 weeks!).

When I was going to try a VBAC with Patrick (after 1 c-section) my OB said
she did not induce with a VBAC. She said you didn't want to force a uterus
that wasn't ready, and had a weak spot.

My blood pressure was a bit high at the last appointment, but
came down when I layed down for a bit. That may be what
prompted her comment about inducing.

She also told us to have lots of sex and go to a local
restaurant and get their eggplant parmisan, guarenteed to
put you in labor!

Mary

I'd go to the restaurant anyway - lol.

On Fri, 23 Jul 2004 10:56:06 -0400, "Mary W."
snuck out of the ether to utter:

, and then she asked me how I felt about induction. I
was surprised, thinking they wouldn't induce a VBAC. She said they
wouldn't do the cervix ripening gels, but would do a low dose
pitocin. Any thoughts?

I experienced low dose pit while attempting a VBAC.
My membranes had ruptured early the previous morning and I'd tried
every non-intervention technique I could manage for about 30 hours
before I consented to the pit. They started the drip rate at 6 (I
believe it's normally at 30), and did turn it up a couple times until
I told them not to, as my contractions were *very* strong.
A couple hours later and I still wouldn't dilate beyond 2 cm so I
consented to Nubain. Still no dilation, so hours later I consented to
an epidural. 2 1/2 hours later and still no dilation beyond 3.
I was so exhausted by that time I chose an RCS after deciding I'd done
everything I could to VBAC.
I don't feel the Pit lead to an RCS, as she'd never descended and I
wouldn't dilate so I'd have had the RCS regardless....

Just thought I'd share my personal experience.

Nan
--
"when the sun goes down we'll be groovin'
when the sun goes down we'll be feelin' alright,
when the sun sinks down over the water
everything gets hotter when the sun goes down"
~Kenny Chesney

Nan wrote:

On Fri, 23 Jul 2004 10:56:06 -0400, "Mary W."
snuck out of the ether to utter:

, and then she asked me how I felt about induction. I
was surprised, thinking they wouldn't induce a VBAC. She said they
wouldn't do the cervix ripening gels, but would do a low dose
pitocin. Any thoughts?

I experienced low dose pit while attempting a VBAC.
My membranes had ruptured early the previous morning and I'd tried
every non-intervention technique I could manage for about 30 hours
before I consented to the pit. They started the drip rate at 6 (I
believe it's normally at 30), and did turn it up a couple times until
I told them not to, as my contractions were *very* strong.
A couple hours later and I still wouldn't dilate beyond 2 cm so I
consented to Nubain. Still no dilation, so hours later I consented to
an epidural. 2 1/2 hours later and still no dilation beyond 3.
I was so exhausted by that time I chose an RCS after deciding I'd done
everything I could to VBAC.
I don't feel the Pit lead to an RCS, as she'd never descended and I
wouldn't dilate so I'd have had the RCS regardless....

Just thought I'd share my personal experience.

Thanks Nan, I appreciate it! Not descending was the reason
for my c-section (after my water broke on its own before
labor started). I suspect she was malpositioned. This baby,
while floating, seems to be in a very good position.

From the article I posted, it looks like pit only induction
barely increases the rupture rate. So if faced with an
ERCS or pit induction, I might just go with the induction.

Mary

Sophie wrote:

My midwife kind of threw me for a loop at my last appointment. I'm due
tomorrow (July 24) and have no signs of impending labor. I'm trying
for a VBAC (DD's c-section was over 3 years ago). So on Wed, I was
talking to the midwife and we were discussing what the next two
weeks brings. An ultrasound at 41 weeks to make sure things are
going well, and then she asked me how I felt about induction. I
was surprised, thinking they wouldn't induce a VBAC. She said they
wouldn't do the cervix ripening gels, but would do a low dose
pitocin. Any thoughts? I'm going to do some digging in the literature,
although I have time since we are talking at the earliest 41 weeks
and they'll let me go to 42 if everything is OK with baby (although
I'm not sure I can stand this for another 2 weeks!).


When I was going to try a VBAC with Patrick (after 1 c-section) my OB said
she did not induce with a VBAC. She said you didn't want to force a uterus
that wasn't ready, and had a weak spot.


That'd be my concern.


My blood pressure was a bit high at the last appointment, but
came down when I layed down for a bit. That may be what
prompted her comment about inducing.

She also told us to have lots of sex and go to a local
restaurant and get their eggplant parmisan, guarenteed to
put you in labor!

Mary


I'd go to the restaurant anyway - lol.



Just might do that!

Mary

On Fri, 23 Jul 2004 15:55:46 -0400, "Mary W."
snuck out of the ether to utter:

Thanks Nan, I appreciate it! Not descending was the reason
for my c-section (after my water broke on its own before
labor started). I suspect she was malpositioned. This baby,
while floating, seems to be in a very good position.

From the article I posted, it looks like pit only induction
barely increases the rupture rate. So if faced with an
ERCS or pit induction, I might just go with the induction.

Right, I think the rupture rate remains low. There may also be a
difference between receiving pit once you're in labor v. starting out
with a pit induced labor.

With all the methods I tried, rupture wasn't really a concern for my
doctors, so I felt okay about it.

Nan
--
"when the sun goes down we'll be groovin'
when the sun goes down we'll be feelin' alright,
when the sun sinks down over the water
everything gets hotter when the sun goes down"
~Kenny Chesney

Mary W. says:

I
was surprised, thinking they wouldn't induce a VBAC. She said they
wouldn't do the cervix ripening gels, but would do a low dose
pitocin. Any thoughts?

My VBAC attempt was a low-dose pitocin induction. When it started looking
like I might hit 42w with no onset of labor, I discussed AROM vs. pitocin
with my midwives. In the end, I decided on pitocin because I was concerned
that AROM might bring on malpresentation, which was the cause of my first
c/s. I also figured that we could still do AROM if the low dose of pitocin
didn't end up working.

I was induced at 42w+1d, and they started on a very low dose of pitocin. I
have no idea what units we're talking about here, but I believe they
started at 2 and increased by 2 every hour. With such a low dose, it took
awhile for labor to start at all, and that interim period of waiting for
contractions to start was very frustrating, especially since I was very
disappointed to be having an induction at all. After the contractions
started, it seemed like the dose we were at started to become too much, so
the midwife turned it down a bit. I honestly had been hoping that the
pitocin would just sort of help my body kick into labor, but it didn't
happen that way. Many hours into it, I requested an epidural; they turned
the pitocin off while trying to place the needle, and my contractions
stopped entirely. :-\

-- Alpha
mom to Eamon and Quinn