Inducement not allowed if trying for a VBAC???

I was talking to a friend today (who has a friend going to try for a VBAC), and she tells me (according to her friends doctor), if you've had a C-section before you're not allowed to be induced subsequent births? Is that right - anyone else heard / been told this? What's the reason for it?

My first had to be induced and resulted in an emergency c-section after 10hrs labour & no progression and baby in distress.......anyway, we're TTC #2 at the moment and I was all for trying a VBAC but the no inducement thing got me a bit worried. If you don't go into natural labour, there's nothing else they can do to try for natural birth?? Seems so unfair.

The reason they won't induce with a VBAC is because artificially stimulating labour increases the risk of a uterine rupture.
However, they also get very antsy about vbac mums going past 40 weeks as well, which is very frustrating because some babies are just not ready to come at that point.
If you're wanting a vbac it really is best to go into labour on your own, because induction in itself is more likely to lead to an emergency caesarean. So if you're trying to avoid another ceasar, avoiding induction is a wise idea.

If you get to your due date and nothing is happening, cervix not looking favourable or whatever that's when the natterings about booking for a c/section will start (if they haven't already). At this point it is up to mum to remember everything she knows about vbac, going post dates etc and stand her ground. She can ask for daily monitoring etc and ultimately no one can make her have a caesarean. This is easy to say but mums are emotionally very vulnerable at the end of pregnancy and are all to often trampled and bullied and guilted into things they don't want. The trick is to be prepared for all this before it happens - do the research so you know you can't be guilted, make sure you have good support around you etc.

Oh also with a second baby you're more likely to be a bit dilated at the end of pregnancy, so they can break your waters. This could be enough to send you into labour on your own but the drawback is that if it doesn't, you'd probably be straight off to theatre since they can't put you on the drip. So it's a bit of a catch 22 that option. But if you're staring down the barrel of a scheduled c/s anyway to me it would be worth the risk but that's a decision only you can make.

As Flea said, the risk of uterine rupture is higher in women having a VBAC labour chemically induced. What worries you about not being induced? Personally, I would have thought having that pressure off would be a good thing ;-) The thing is, babies come when they are ready. Term is anywhere from 37-42 weeks so that is a huge timeframe. The biggest issue you will find with an ob as your caregiver will be the pressure to have a c-section if you go past your estimated due date, which is just that, an estimate :-)
Do your research beforehand so you are a little more prepared for some of the pressures you will face. Or better yet, choose the path of least resistance and choose a care provider who believes that birth is normal and babies come when they are good and ready ;-)

So what would happen if you tried to be adament with the MW or Obs that you didnt want to book a c section that you wanted to wait till bubs started labour on it own???
Would they look to turn you away or something drastic like that or would you still be treated but have to sign a waiver of sorts????
I am 3 weeks of my very sought after VBAC and I had never considered these things... SILLY ME! :(

Flea.... are you a practising Doula as yet????

Thanks for your replies.

It doesn't worry me not being induced...it was more because I went to 41 weeks with the first pregnancy, what if it happens again and I get to 42 weeks (which i'd be prepared to do) and haven't gone into natural labour by then. It just struck me that your choices are reduced if you can't try and 'help' it along. I know there are natural alternatives etc, but just really wondered if you've tried all those why you couldn't be induced with drugs etc. I'd never heard of it before and just wondered.

What you've said makes sense. Cheers

My first was born at 42 + 4 days induced resulting in c/s. With my second I did heaps of research & had a doula prepared for going overdue. I was told at 40 weeks that I needed to be booked in to be induced, but I had to be monitored the entire time. I refused. As the others have said, it took a lot of hard work on my part to stand up to the OB's at the hospital & make sure it was my choice. I was told my baby would die because of me being stubborn, but they had no evidence that was the case. I asked for a scan to stall time & it worked, I had the scan on Tuesday & on Wednesday night I went into spontaneous labour.

Be strong & have support around you prepared to help you through the battle if you need too. You can still have a VBAC, my VBAC baby was born at 41 + 3 days.

Yup... as said it's because with inducement it's usually quite full on straight away so it isn't recommended with a prior c/s.

I had a successful VBAC... loved it by the way. I went 4 days over and there was NO mention at all of a possible c/s at that stage so I was EXTREMELY happy about that. The midwife was like ... and why would you need to... when I asked her about going past EDD and c/s etc. So, it was great! Which hossy would you be going to? Oh and I was a spontaneous labour (didn't go into labour with number one as he was a c/s due to breech).

Hey Kirstie :)

They can't turn you away from a public hospital if you refuse to have a caesar. They may ask you to sign an indemnity but they would try other means first.
What they will do instead (and this is by no means always the case, but if they're hell bent on coercing you this is the usual tactic) is tell you that your putting your baby at risk by going too far post dates. Let's book a caesar and get baby out... and who knows maybe you'll go into labour before then anyway...think about your baby....dadada....

This sort of talk is very, very difficult for a pregnant person who is close to meeting her baby and who is totally hormonally geared towards doing everything possible to protect her baby, to process rationally. And they know that.

To a mum who either doesn't know that she has options (ie monitoring), or doesn't know that EDD's are just guesses about when a baby might come, and who doesn't have support from anyone around her (ie. hubby siding with the hospital so she's out on a limb) it's very easy for them to basically guilt trip you or frighten you into agreeing to a caesar. So they don't really have to pull out the "big guns" and say find another hospital, they just manipulate you emotionally.

It's pretty disgraceful yet it happens so often :( Blatant abuse of trust and power IMO, especially when they not only coerce women with emotional blackmail, but they present the c/section as being a practically risk free procedure in comparison to simply going post dates with a healthy pregnancy. So not the case!

Anyway I'm rambling lol...yep I'm a doula now Kristie.

Tobily - aka Flea :) Thanks for that.... I was speaking with DH about it and told him what they could possibly say to me if I go over... We discussed the possibility of a ceaser again.... But now that I am armed with a little bit more info I will talk to him again.... He wants me to have the labour I want but the moment they get to him emotionally then its gonna be out the door! If they say to him that baby IS distressed he will be on my case big time to have the ceaser... But if they say baby COULD be distressed he will tell them to pee off until baby comes on her own (within reason of course)
I have a list of questions that I am going in with at my 38.5 week visit so see what they say and I may PM you for some advice if that would be ok!

Sorry I was rambling there but at least if I have him filled in on thier "tactics" then we will be ok.
Thank you Fi!

Amygirl... Sorry to have pinched your topic there and run away with it.... You definately hit a nerve for me with your question and not a moment too soon!!! THANKS :)
xo

No worries Kristie :)

If DH is going to be the person who will be sticking up for you in labour it's really important that you talk together beforehand about the sorts of things that might be thrown at you and how you might handle them. I don't mean it to sound like an "us" against "them" thing in terms of the hospital - but the reality is that if you're having a vbac in hospital and your labour in any way varies from what they "like" to see - ie takes longer, stops and starts a bit, etc (all very normal in labour but doesn't fit with their get-the-baby-born-in-12-hours-or-less mindset) then you'll probably encounter pressure so having a strategy to deal with it is always a good thing ;)

Kirstie... with Oskar he was in distress (very dark meconium coloured water) and his heartrate was dropping to around 40 bpm at the end of every contraction. I still had a natural VBAC (no drugs) with vacuum assist as doc suggested very strongly we needed to get him out asap... having said that his apgar was 9 I think from memory... so he was fine once he got out!! ]

I see you are at Caboolture.. I'm not far from there. Are you having bubs at Caboolture hossy?? That's where I had Oskar and they were fabulous.

Tobily - Thanks so much, its good just to be armed with information and knowing that you do have choice ... it seems in the public hospitals you just have to be firm with them.

Cass - Yep am having bubs at Caboolture :)... They seem ok so far in relation to appiontments and stuff... not much to go on as I am normal every day pregnancy so they are quiet quick with me.. Its nice I have to say as I have not heard 1 bad thing about Caboolture at all!! I had my little man at Redcliffe and sadly there are nothing but bad or semi bad experiences re that hospital, including mine.

Thanks guys :D
xo

I hope you have a wonderful experience at Caboolture.

Hey everyone I am new to this site , and this is the most helpful information I have heard about VBAC's coming from real women and not some written literature of a professional saying all the awful things that may happen. It's nice to know there is possibility in natural birth even after a c section. My 1st was a c section because she was 10 pound 2 and I went overdue with her and her head would not engage. I really am hoping to try VBAC, but am worried I may be hoping a little too much given the size of my last baby, because I have heard they are meant to get bigger with each one too. I am having a scan at 34 weeks to check the size of him and then at 36 weeks my obstetrician wants me to decide which way I am going to go. It only makes sense to go to full term and then decide I feel he is jumping the gun a litttle, with making a decision, maybe its because of my previous c section, I dont know. But I will have to wait and see how big he is I suppose I so badly want to give birth naturally. I had a horrible time recovering after my 1st, it was 6 months and I had blood clotting and all sorts after, I dont want to go through that for that long again. No matter what some may say about C sections being the easy way I out, I fully disagree with that, because of the recovery time involved. Babies are meant to come out naturally though but sometimes in certain cases they cant, I just hope this doesnt happen to me again.

Just thought Id say hi, and thanks for all the information on VBAC's.

Danielle.

Danielle it is scary, have you access to any books about natural birth for the other side of the story? A very good one is Silent Knife and another is A Thinking Woman's Guide to Better Birth. You can look on the main site for ordering online :) Good luck, it is possible & you can do it!

Hi Girls,

I had my first bub in Sept last year by caesarean because I had pre-eclampsia and her head wasn't engaged so an induction would not have worked. Unfortunately the anaesthetist couldn't get the epidural in so I had to go under a general anaesthetic. I found the whole experience very traumatic and I'm really hoping for a VBAC next time. Initially I was told by hospital staff that if I wanted to have a VBAC with #2 I couldn't have it at that hospital (Pindara on the Gold Coast), but I have since found out, that my OB is one of only 2 OBs from Pindara that DO allow VBAC'S there, the rest insist on another caesar. My OB is open to the idea of me having a VBAC but has warned me that I'll probably need another caesar because #1 bub's head wasn't engaged which indicates my pelvis won't fit a baby through - so I know that my OB probably already has the pre-conceived idea that I'll be having another caesar. However, what I've read in this discussion has given me the strength to make sure that I allow my body the time needed to see if I go into spontaneous labour.

One other thing, does anyone know if there is a minimum length of time you should wait to fall preg after a caesarean if you want to have a VBAC????

Charli'smumma - have you read the article on pelvis size here? Not sure what it's called....but it's very interesting. The long and short of it is that there's only a teeny tiny % of women with pelvis' too small to birth through (trivia: did you know that squatting during labour can open your pelvis up 30% more than lying on your back?!!!!). Whilst you might be in that teeny tiny %, well, you also might not be.

Not sure if that's right about second babies being bigger either....

Charli'smumma, just wanted to let you know that my step-sister's first bub was almost 10lbs, and her second was only 7.5lbs. They were both boys too.

Silent Knife is in stock at the moment, The Thinking Woman's Guide should be in very soon - it's in transit!

Thanks for your replies girls. My first bub wasn't overly big - 7lb 8oz so it wasn't her size preventing her from engaging (well I don't think anyway). The OB didn't really tell me too much. I'll have to read the article about pelvises. Maybe bub was just in a funny position I don't know. I'm not exactly a tiny person myself so I really hope that my next bub does engage. Apparently I won't go into spontaneous labour if it doesn't???

many babies don't engage until labour starts or even for a few hours after labour starts especially for second and subsequent births. Dont be fooled by the myths propogated by those all to willing to surgically remove your precious baby. It's just more scaremongering, they just need to wait !

Thanks Smilie10P, For some reason I thought that I wouldn't go into spontaneous labour unless my baby's head was actually engaged. I'll definately be trying to hold out as long as I can next time before going down the caesarean road again!

My (first and only) baby's head engaged fully about 3 hours after my labour began. I was 2/5ths engaged a few times before then but she was still bobbing up and down. It wasn't until my contractions were going well that she moved right down. She was born at 41+4 so it's not like she was pre-term. I'm 181cm tall and one of my midwives said she doesn't pay much attention to engagement in taller women as the baby often has a lot more up-and-down space to muck about in.

If bubs is more than 14 days overdue and still not at all engaged or labour has been strong for many hours and the head is not descending, then you MIGHT have a baby too big (far more likely to just be in a funny position) to fit through...maybe.

Many second babies are a little bigger than 1st babies, (and many aren't) but then many first babies are born surgucally when they could have been born vaginally. Obviously your bub had to be born due to your PE and inducing when the head is very high increases the risk of cord prolapse (when the cord is washed down past the head and through the cervix, putting it at risk of complete compression) which is a dire emergency. It's likely that without the PE Charli would have engaged and been born just fine. :)

Bx

Thanks Hoobley, I hope you are right :) Fingers crossed I don't have PE next time. I have heard that it's less common in subsequent pregnancies??? I don't think Charli's head was at all engaged (well that's what my OB indicated) but she could have just been in a funny position. She was born with a pointy head though and I expected a really round head being a caesar so that does make me wonder whether she was actually partially engaged. . . My elective caesar under a general robbed me of a birth experience and that precious bonding time. I never want it to happen again so I'll be trying my hardest for a VBAC all the way . . .

Sorry guys, I got this thread a bit off track but back to inducement for VBAC. I did read somewhere that besides being able to rupture the membranes apparently they can insert a catheter to just inside the uterus and blow the balloon up to try to put pressure on the cervix to start dialating and to try and stimulate the natural labour hormones. Not sure how often this kind of thing is done but if you go way overdue and you are staring down the barrel of another caesar maybe it is an option?

Yes some hospitals use a foley catheter to induce VBAC women, but ideally all goes well/healthy and you don't get induced in the first place :) Because at the end of the day, an induction can fail, especially if the body/baby isn't ready, then you only have one option left.

hi guys, glad to hear of the discussion about VBAC I am a junior midwife at a maternity tertiary referral centre in WA. VBAC is no big deal for us. Those of you who have experienced negativity in response to wanting a VBAC should pursue other care providers. In my experience, public hospitals are more advanced in these areas and have 24 hour care so if a VBAC is unsuccessful and you need a NELUSCS (non elective) it's no big woop di do. In bigger hospitals the fewer women electing a c/section straight off the better. That's not to say the care is unsafe, just more individualised. Doctors are not on a time schedule, theatre staff work 24/7 along with the rest of us.

Charli's mumma: the recommended time frame after c/section to allowthe scar to heal is 18 months.

Babies do not necessarily get bigger as you have more. the size is really dependant on many things, your health at the time (blood pressure etc), the placental health and how the placenta is implanted into the wall of the uterus.

The best school of thought is every woman is entitled to a trial of labour, not all of your babies will engage into the pelvis in the same way, so the second time round after a c/section your baby may engage into the pelvis in a way that is accessible for it to birth in comaprison to your previous. Labour is usually shorter the more babies you have and you are most likely to be overdue for your first one. Although it can still happen.

60-74% women can go on and have a successful VBAC (with lower uterine scar). Induction does increase your risk of an emergency c/section slightly in comparison to going into spontaneous labour but induction is still considered a reasonable thing to do as long as there isn't other risk factors. Women who had c/sections previously for breech, pre-eclampsia are in the most favourable category for VBAC, along with women who had a vaginal birth prior to the c/section.

A c/section for failed progress in second stage is also favourable, because it indicates the cervix can dilate. However it may indicate problem with the descent of the baby's head. So it has trouble making it's way down the passage. Descent can be aided by upright labour, mobilisation and active labour, no epidural till in established labour. Failure in first stage (cervix stops dilating) indicate a problem with size proportion (baby vs pelvis) however every labour is different and the engagement may be slightly different. Sometimes if the head isn't applied well to the cervix it doesn't have the pressure on it to make it dilate. However it can come down to the angle of the baby's head when engaged which may have held it up last time....not the size. Different parts of the head are bigger than others in diameter.

There are many variables and that is why even if you didn't succeed (sorry wish I had a better term) in first stage or second stage doesn't mean the variables will be different next time. A cervix which has dilated to 6cm will dilate better the next time than one that has never had to do anything.

There is an organisation you can access called Birthrites, it's in WA (i think maybe national as well), lots of info there about VBAC.

When someone tells you that you can't go past certain dates for a VBAC, ask yourself if that's logical. Did you have a previous c/section for size last time, or was it another reason, breech, c/section. If so was size even an issue. Most women will have a baby that's the right size for them, unless you are a diabetic, than early induction is recommended.

So, induction of labour is done with VBAC in some hospitals, so do some research. Look around for a practitioner who isn't scared of VBAC and normal birth, somewhere midwives practice along side doctors is a good place to start.

Good luck, you have a right to a trial of labour, trying for a vaginal birth after c/section can prevent many complications for future pregnancies such as placenta praevia, placenta acrete and repeat c/sections. Cheers mushka

I have had 2 successful vbacs after my first breech baby was born by c section. My second pregnancy was induced by breaking my waters to see if labour would start as my amniotic fluid was on the low to normal level and I was told if I didn't deliver that night I would be up for another c section. After having my waters broken (I was luckily 2 cm at 39 weeks) and a cervical sweep( ouch) my contractions came on FAST!! You can ask for a stretch and sweep at your 40 week appointment to see if it gets things going. Then try every natural method and wives tale known to man. I also used raspberry leaf tea towards the end of my pregnancy ( 36 weeks) and I swear it helped my uterus contract. All my babies came under 2 hours. Have you also considered having someone else present at the birth, along with your husband. I think it's really important to have someone with you that will be a strong advocate for you.

hey,

I just noticed mushka's reply to this thread, it was full of information I didn't know yet, I am learning very fast about VBAC'S :D. I was just wondering, it was mentioned that women who have had a c section in the past for breech bubs or medical conditions like pre-eclampsia are more favourable for VBAC.

Is this why my doctor didnt like the idea of me attempting VBAC, because my baby was posterior, a big baby of 10lbs 2 oz, and her head was more like sitting on my pelvis instead of going under, does that mean that it may lower my chances of VBAC this time, because of the baby to pelvis ratio, that it may be more likely to occur again? Also my body has experienced no labour what so ever - could that also have an impact on weather it would be successful?

Can I ask why you didn't labour last time? How did your dr/midwife know the baby wasn't going to fit without labour? Lots of babies are posterior and to be honest, that's a shocking sole reason to have a section.

Forget the term 'trial of labour/scar', it just spells out failure. It's horrible yuk medico speak. It's just a birth. Not a VBAC birth - just a birth. Your best option is to hire a care provider who will treat it as such - not a rupture waiting to happen.

Wow Mushka, thanks for all your input, there's a lot of great info in there!

Jo+3, I think with my next pregnancy I'll be asking for the stretch and sweep if I get to 40 weeks and nothing has happened. It can't hurt to try it hey . . .

Danielle, I didn't have any labour with DD either and I am dearly hoping for a VBAC next time. I've read on this site that there is a lot of evidence out there to suggest that this so called "pelvis too small or baby too big to fit" problem doesn't exist in most cases. Lets hope that the so called experts who tell us that our baby wont fit are wrong and that we will have a great VBAC for our next births!