Artificial Rupture of Membranes for VBACer`s?

Hi.
I have been told by the Ob that when I get over my due date they will have me booked in for a c.section a few days before Im 42 weeks. I also will have the choice of having my waters artificially broken.
I do not see the Ob for a few weeks, so will have to wait til then to discuss it with her, but would like any info about how successful artificial rupture is and roughly how long they give you till they go ahead with c.section if nothing happens and any risks and well anything anyone can share with me about this possible choice of procedure.
I`m not real keen on the idea of it, but tbh, I do not really know much about it in regards to VBACing, so share your knowledge here please!! :D

i am no expert on the subject, but as far as I have read they do not rupture your membranes with a VBAC you have a higher chance of the scar rupturing due to increased contractions.

Actually, if bubs head is down they can rupture membranes for you Miss_H and there is no study to show that there are increased contractions.... Yes they are more intense with medical inductions, but that is why they usually won't do a medical indcution, but they can rupture membranes, if bubs head is engaged.

I got to 42 weeks and they discussed rupturing membranes at 41+5 but bubs head was still too high and there was a risk of cord prolapse so we couldn't do it. I strongly suggest acupuncture in the next few weeks leading up to and after your due date Salsa and definitely consider AROM if it is possible. It may just be enough to get your labour moving if things are slow and you have been pre-labouring etc. Each hospital is different as far as how long they will let you go so I would talk to them about what happens after your AROM and how long they will let you wait. Good luck hun and keep talking and asking questions!

I was booked in to have ARM on the Monday, but bub arrived on the Saturday before so I have some basic info about it ;)

Essentially what we were planning was ARM at 7am and I would be given roughly 8 hours to get contractions happening. I was going to be left to it after the ARM was done with basic monitoring every few hours, so I was going to be allowed to walk the ward & hospital grounds to try & get contractions started. I was not going to be allowed to go home from then on though. Once it got to the 8 hours if contractions hadn't started, the plan was to do a very very tiny dose of synto to try & get them going. If that didn't work it would be straight to a c/s.

As it turned out, my waters broke on their own on the Friday night before it was all booked in.

My hospital has a policy of no inductions for Vbac, and they give you the choice of trying artificial rupture prior to another c.sect. But I have not managed to find much info on it being used for Vbac.... I wonder if they do it then they make you stay in and be monitored - which doessnt sound much fun, but thats just guessing



ETA . I just posted this and then saw the other replies.
Is there a way of knowing yourself if baby has their head engaged? Or is that like dilation and can only be judged by a professional?

Some people can feel bub "drop" but really you need a midwife or Dr to cehck bubs head in your pelvis and they will say how far down it is. Izzy only ever got to 2/5's engaged and James didn't at all. I would say that yes they would like you to stay in for monitoring but remember you can say no, especially in the early stages after they rupture them. You could say you want to walk around the hosptial grounds etc until labour establishes...

I will have a look at some of the stuff I have when I get home and see if it mentions ARM for you.

I prob should know a bit more about this :redface: when you say "rupture the membranes" is that the same as breaking the waters? I was in labour for a while and my bp dropped quite low but my waters hadn't broken so the midwife broke my waters and everything started happening. I deivered fine (had an epi) didn't have to use forceps or anything.

HTH :)

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I have been told by the Ob that when I get over my due date they will have me booked in for a c.section a few days before Im 42 weeks. I also will have the choice of having my waters artificially broken.

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Is there an option of waiting beyond 42 weeks? Then you can avoid an induction and possibly also a CS :)

I was advised when going through my VBAC not to allow for my membranes to be raptured as you are pretty much timed after they have been ruptured. I went over 5 days and had two sessions of accupuncture, after the first I had the show the next day and after the second went into labour.I am not sure if you have heard of a sweep and scoup but that also helps the cervix with softening.........

As a rule, they will not do an ARM for a VBAC because it has been known to stimulate precipitous labour, and as previously mentioned, that increases the risk of a scar rupture. Ideally, a VBAC labour should be allowed to begin spontaneously.

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As a rule, they will not do an ARM for a VBAC because it has been known to stimulate precipitous labour, and as previously mentioned, that increases the risk of a scar rupture. Ideally, a VBAC labour should be allowed to begin spontaneously.

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So Schmickers, would you say its not too different from inducing with a drug, in terms of what may or may not occur from having it?

The ob said hopsital policy is no 'induction' for Vbacs, but she can offer me the ARM towards the end, if I want to try that before proceeding with a c.sect.
She also (to my surprise) said I can be sorted out with an epidural etc if at the time I feel thats what I want to do (refering to spontaneous labour).

In my case a sweep and scoop was done when contractions were 4 mins apart and I was 4cm dilated, I must say it was very effective as it did not intesify the contractions however they became more regular and my son was born 1hour and 10 mins later. I can only speak for myself when I say refusing continuous monitoring, the sweep and scoop and refusing all pain relief it's what determined a succesfull VBAC. You should be able to feel the contractions and any sign of abnormal pain needs to be advised immediately. I know at the Royal Womens and epidrual was not recommended. In regards to continous monitoring I believe it really slows down the labour and you are restirected in moevement and you spend more time staring at the monitor and waiting for something to happen instead of positive thinking and following your instincts. i wanted to have a shower, I wanted to move around and I know with all the cords attached that would not have been possible however near the end of the labour the monitors were placed to monitor the baby as the contractions were really intense.Good luck

I googled 'sweep and scoop', but nothing pregnancy related came up. What is it?

I`m guessing the ARM will be offered and if I accept they will expect me to stay at the hospital - so if anything goes bad then they`ll just do the c.sect, which they are bound to do after how ever many hrs they are happy to wait and see... I`m also guessing if I get the ARM, then they may put the monitor on me then... but this is all guessing. They initally suggested 10 days over, but I want to give it another day or 2 because that increases my chances of natural labour and also I dont want to be having any of this done on DS birthday!

I wonder what the OB will say when I see her next week?

Hopefully none of this will matter and I`ll be laboring nicely well before then.:D

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I googled 'sweep and scoop', but nothing pregnancy related came up. What is it?

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Try "stretch and sweep" or "membrane sweep".
Basically the membranes are manually separated from the cervix using a finger. This stimulates the release of prostaglandins - the aim is to soften up the cervix and/or start labour. It's effectiveness varies, basically depending on how close you are to going into labour on your own anyway. Biggest risk with this is that your membranes will be ruptured accidentally.

I had 4 stretch&sweeps over the course of 10 days. Either none of them worked or the last one did, depending on how you look at it. The most painful (done by an Ob's registrar) was so rough that DD's bum was cracking up against my ribs from the shoving on her, the gentlest, the last one, (done by a midwife with long careful fingers) was completely painless and comfortable and i had mild BH for 4 hours after it, then nothing for 10 hours, then my waters broke on their own.

TBH i'd have a few stretch and sweeps if you go overdue and your cervix is favourable (has to be a little soft and a little open to admit a finger for a sweep). They can be quite effective.

If it were ME trying to VBAC (and i'd be really keen to) i'd ask for a Foley's catheter induction. The foley catheter is as it sounds designed for emptying bladders. They insert the catheter into the bladder and inflate a small balloon on it to keep it from slipping out. They can use this to induce - they put it into the CERVIX and inflate the balloon - the pressure of the balloon between the cervix and membranes stimulates oxytocin production which can bring on labour. If it works the balloon falls out as the cervix opens, if it doesn't work they can deflate and remove it and you can go home - it uses no artificial drugs, doesn't bring on the hard labour which can cause rupture, and is REVERSIBLE, making it the safest form of induction. The biggest risk with it would be that your membranes got ruptured accidentally - same for any cervical examination at that stage of pregnancy.

Bx

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So Schmickers, would you say its not too different from inducing with a drug, in terms of what may or may not occur from having it?

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I'd have to look at the research and speak to my learned wife, or hopefully Alan may see this thread and comment, but from my understanding, it is a much gentler option than a drug-induced labour, but is still considered a form of induction.

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She also (to my surprise) said I can be sorted out with an epidural etc if at the time I feel thats what I want to do (refering to spontaneous labour).

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I wouldn't be surprised so much as concerned. My understanding is that epidural anaesthesia is quite strictly contraindicated during a VBAC, as it prevents you from recognising the signs (ie. suddenly increasing pain) of an impending scar rupture.

I was just coming back to say that Michael!

Epidural is a bad idea for MOST women. If i was trying to VBAC and my Ob offered me an epidural and AROM off the bat i'd think they were basically paving their road to a repeat section without having to argue about it...JMO

Bx

Im not keen on Epidurals - vbac or not, and obviously want to find out more about the suggestions the OB did have but she was also encouraging for me to vbac. Her opinion seemed to be that was a preferable choice, especially if I intend on having other babies later.
Urrggh! I wish having had a c.sect previously didnt hanve all this gaff with it :doh:

Salsa, I think it would be a great idea for you - and set your mind at ease - to do some research about the ins and outs of a VBAC, independent of what your OB has told you. There are lots of great books out there - I'm sure some of the VBACers will pop in and recommend some good reading for you.

Thanks Smickers for the suggestion but I have already been reading books and asking questions. In regards to ARM for VBAC, I have not come across much info so far, hence why I started this thread. I have only had one Ob appointment so far and will probably only have one more next week, so I wanted to get some more background on it before I see her. She seems to be a very good Ob from the one appointment I have had, but I never take any Dr`s opinion as being the absolute gospel. Again, this is why I have posted asking for any advise or knowledge - research or personal experience.

Thanks everyone who has answered so far, I feel I have a bit more understanding of the procedure and what I should probably expect to be hearing from the Ob when I next see her.

Salsa the only danger in ANY labour is that intervention will complicate things and lead to a repeat emergency c-section. The problem with AROM is that there is no going back, you know? Once it's done that baby has to come out, within a day or two, whether you dilate or not. With the Foleys cath you can go home and give it a few more days if it doesn't work. Not all obs do foleys inductions though (even though the rupture and c-section rates are far lower than with a standard pitocin induction, which you couldn't have anyway), so it does depend on the individual doctor.

With a VBAC because the doctors are usually SO keen to do a repeat section (and i want to make it clear that that's due to fear of complications and litigations, NOT unprofessionalism - even a good ob can be scared enough of normal labour to interfere to everyone's detriment not because women all have terrible problems but because when a woman DOES have a problem it's an ob who sees it - those experiences are bound to add up, even if all the evidence is that for normal women VBAC is perfectly possible and desireable) that staying away from as much intervention is possible gives you the best chance of getting a VBAC. As soon as your waters are broken they will be watching the clock, and even though it can be completely normal for a healthy woman to NATURALLY break her waters and wait 2-3 days for contractions to get going, many would-be VBACers are sectioned again because it's been 6 hours since AROM, nothing seems to be "happening" and everyone is getting twitchy.

I would ask your doctor:
1) How many days post dates would s/he want to do AROM? (less than 14 is usually unnecessary, depending on the health of bubs and placenta, but remember 42 weeks IS term, you're not actually "post" the average gestation until you hit 42+1)
2) How long after AROM would s/he be happy to allow you to establish labour on your own (24+ hours is NOT excessive if you are able to be monitored during that time and are comfortable)?
3) Does s/he do Foleys Catheter inductions and would s/he consider trying that before AROM in your case if you went post dates?

HTH

Bx