So, I think I'm going to ask to be induced for VBAC

[~mamaspice~]

I was very surprised recently when I had an appointment with one of the head Ob's at our local hospital who said that they WOULD allow the use of syntocinon to induce for VBAC.

I have insulin controlled GDM this pregnancy and a baby that is on the larger side. The head Ob said he wouldn't feel very comfortable letting me go beyond 40 weeks, and personally, my intuition tells me the same.

I have also recently read through ACOG's latest VBAC Clinical Management Guidelines that my lovely student mid sent through to me, which states that induction of labour for maternal or fetal indications remains an option for women undergoing a trial of labour after caesarean. It then goes on to talk data about several studies. One study of 20,095 women found a rate of uterine rupture in spontaneous labour to be 0.52% as opposed to 0.77% for induced labour (without prostaglandins). This to me, doesn't seem to be too much more of a risk witht he use of a little synto IYKWIM.

So, if I get to 40 weeks I'm seriously considering asking for a low dose syntocinon induction instead of heading straight for an elective repeat caesarean. Obviously this would depend on whether my cervix was "favourable".


Has anyone else had a VBAC or attempted VBAC with the use of syntocinon?

[black_rose]

My ob refuses to do it, he says the risk isn't worth it, even though it's now been three years. He supported me through a vbac last year with dd2 even though I had gd. We have talked it over and I can try for another vbac but I will be prepped for a c sect jic.

[Arimeh]

My (very supportive) OB who was considered to be quite a risk taker by other OB's would most definitely NOT induce me when I went over with DD1. She said it was FAR too risky. Can you ask for the balloon method instead? She was willing to do that way, and then break my waters if I was ok with it, but never EVER did she mention syntocin as a way to induce.

And to be honest babe - I wouldn't want it. I would rather have an elective c-section, cos if bubs isn't ready to come out, then it probably ain't gonna wanna come out too nicely with force

[feeb]

My OB would only do ARM would not give synt. I didn't want anymore than that anyway.

[Cherished]

hi hon, the only thing I know about induction is what we learnt at our anti natal class at the hospital and from what we were told any type of induction will usually lead to 'more' intervention if that makes sense. In the case of using the gel it will often led to artificially rupturing the membranes, in the case of an epi it will most times lead to synto to get labour started again as the epi can stop or dramatically slow down the contractions. In the case of the synto it brings on the labour hard and fast and is pretty painful and will often end up in a C-Section anyway and or the use of an epi due to the increase intensity of the contractions. I know that isn't very helpful really but that's about all I know on the topic. Can you as your OB or your midwife some more questions? Are you on weekly visits now?

[onthefly]

I'm no expert on VBACs but I'm pretty sure it is not recommended practice to combine VBAC with syntocin given the multiplication in rupture risk rate. Other forms of induction may be the go if your cervix is favourable.
Good luck with it all - Guess you've still got a good month at this point.

[BellyBelly]

Syntocinon has a risk of rupture, previous c/s or not, so it's increasing your chances on top of the 0.7% with a VBAC. Up to you if you want to accept it. Most VBACs are induced with a foley's catheter or balloon induction... but get onto acupuncture, inserting EPO capsules which are used well with VBAC women and other natural methods. You can say no, they can get sued for doing things against your will.

[~mamaspice~]

Thanks for your thoughts everyone

Ya know, until recently I would have had the same opinion as everyone else in here who has posted so far - That syntocinon for VBAC would be wayyy too risky. But when you read the latest data on the subject it indicates that with careful usage (such as in mother with favourable cervix, low dosage only, with careful monitoring and in a tertiary facility) it may not be as bad as first thought. In the latest ACOG clinical guidelines of all the most recent studies the highest rate or rupture with syntocinon use in women with one previous LUSCS who had never laboured before (which is me!) is 1.5% versus 0.8% in those who had a spontaneous labour, so twice as likely. But when you look at the big scheme of things, the risk or cord prolapse in ANY labour is around 2.5% so a cord prolapse is more likely to occur in any labour than a rupture in a syntocinon induced VBAC.

It's a hard decision. And I'll have to read up again on the risks of elective repeat caesarean too

[Ilithyia]

Hi Mama!

Now put me in my place if you feel I am out, but other than the apparent "big baby", what are YOUR reason's for wanting to induced?

As its been said, it is your choice if you decide whether to be induced or not.

In saying that, I am a firm believer in mothers/womens intuition.

Would you be willing to wait until 40 weeks for labour to start on its own?

[BellyBelly]

I second Sara's posts... sounds like you might be keen for an induction yourself? It's not just a rupture risk we're talking here, more likely pain relief and definitely a repeat C/S. Anyone who truly has their heart set on a VBAC needs to minimise any possibility of a repeat c/s... an induction with a prior c/s is just tempting it.... just my opinion.

[~mamaspice~]

Grrr, I just typed a big reply and lost it all!

Hi Mama!

Now put me in my place if you feel I am out, but other than the apparent "big baby", what are YOUR reason's for wanting to induced?

As its been said, it is your choice if you decide whether to be induced or not.

In saying that, I am a firm believer in mothers/womens intuition.

Would you be willing to wait until 40 weeks for labour to start on its own?

Hey Sara, no need for me to put you in your place at all. I certainly see where you are coming from

It's not so much that I WANT to be induced, it's more a thought of, well maybe I should give that a go instead of just having an elective CS if I don't go into spontaneous labour before 40 weeks.

There are a few medical and emotional reasons as to why I don't feel comfortable going past 40 weeks - scarred uterus and insulin dependant GDM with possible macrosomic fetus is one. (I've never laboured before, also my first born never engaged, so we're uncertain of what my body is capable of birthing, let alone the extra pressure a macrosomic baby *might* put on my uterine scar.) Also having GDM and being overweight increases my risk of stillbirth beyond 38 weeks. And I do have an uneasy feeling about stillbirth, whether that is intuition or fear I'm not entirely sure.
And sometimes I think that when it comes to medical conditions in pregnancy, there is the need to think about, at what point is the baby better off out than in IYKWIM. Is it better for my baby to be born a little early as opposed to potentially subjecting him to higher than normal BSL's and insulin levels, and it's associated risks until 42 weeks?

So my decision has been that I would book an elective CS for around 40 weeks and hope and that I go into spontaenous labour beforehand. I have been reading up on natural induction techniques and acupuncture and EPO are certainly things I will be doing. I've already had some acupuncture and moxibustion as bub was breech and it worked .

Until the other day I didn't know that induction was an option (apart from the use of a trans-cervical catheter or AROM) so then it got me thinking that instead of just going straight to theatre at 40 weeks, perhaps induction with synto is an option.
I know all about the cascade of intervention and the increased risk of CS that comes along with induction but perhaps I might feel better about it all having at least given it a go instead of just opting for a repeat ECS if that makes sense.

[Ilithyia]

Ok fair enough.

As I said its completely your choice and I hope you get the outcome you want.

This is how I see it....

Taking into consideration that your aiming for VBAC, you've got GD, an apparent big baby letting nature take its course would seem to be the best course of action.

However, also taking into consideration your emotions, the "big baby" fact and from what you've said, an antsy OB...induction may be a good option too.

BUT!

Is inducing labour due to a big baby worth the risk of rupturing your uterus and therefore risking any future chance of vaginal birth?

I hope that doesnt come out wrong.

[~mamaspice~]

Ok fair enough.

As I said its completely your choice and I hope you get the outcome you want.

This is how I see it....

Taking into consideration that your aiming for VBAC, you've got GD, an apparent big baby letting nature take its course would seem to be the best course of action.

However, also taking into consideration your emotions, the "big baby" fact and from what you've said, an antsy OB...induction may be a good option too.

BUT!

Is inducing labour due to a big baby worth the risk of rupturing your uterus and therefore risking any future chance of vaginal birth?

I hope that doesnt come out wrong.

Yeah, I see what you mean. I'm not sure if you saw what I added in later in my previous post but it was basically that I feel that some times with medical conditions in pregnancy it gets to a point where you have to consider *when* is my baby better off out than in IYKWIM. So I guess in my case with having insulin controlled GDM, apart from the chance of him being macrosomic, there is a very real chance he could end up in SCN because of other complications related to the GD (EG: low BSL, jaundice and high red blood cell count) And so at what point is my baby going to be better off on the outside. Does he really need to be subjected to higher than normal BSL's and insulin levels and it's associated risks beyond 40 weeks? There is also some evidence to suggest that GDM and additional insulin can accelerate the maturation of the placenta and cord function. I guess that's why the hospital isn't keen for me to go beyond 40 weeks, and personally why I don't really want to either. I couldn't live with myself if I pushed on to 42 weeks just to see if I went into labour on my own, and something happened to bub. So I guess the issue is more than just a macrosomic baby. Even a completely normal size GD baby can have health complications.

Also to look from another perspective, say I did hold off and go into spontaneous labour after 40 weeks and bub was indeed quite big, the extra work my uterus would be doing with contractions to try to push a baby down that possibly wasn't fitting would also increase my rupture risk. Perhaps equal to or even moreso than a synto induction.

I don't know. I guess I'm just trying to evaluate all of the possibilities and trying to establish whether ECS or induction at 40 weeks is the better option for me and my baby. And i guess I have to prepare myself for the fact that a CS could be under a GA again as my last one was due to epi/spinal failure, and that really wasn't cool

[Ilithyia]

I totally understand what you mean.

As I originally said, I am a firm believer in mothers/womans intuition so I completely trust that you know what is best for you and your baby.

I'll keep my fingers and toes crossed for a VBAC for you. But I wish you all the best no matter what happens.

Good luck hun!

[~mamaspice~]

I totally understand what you mean.

As I originally said, I am a firm believer in mothers/womans intuition so I completely trust that you know what is best for you and your baby.

I'll keep my fingers and toes crossed for a VBAC for you. But I wish you all the best no matter what happens.

Good luck hun!

thanks mate. If all the conditions are looking favourable, I think I'll give "gentle" induction a go and see what happens. Obviously if it doesn't start labour off nicely I'll be sectioned but at least I would have tried.

[Shanti]

Mamaspice looking forward to hearing how it all went!! Congrats again on Brock's arrival!!

[~mamaspice~]

Hi Shanti,

I wasn't induced. I had a caesarean, but it was a beautiful experience. I saw my baby being lifted out and he was placed on my chest straight away. I was never separated from him.

[Trillian]

Hi Mamaspice, I'm so glad to hear that he is here! Do you think that his birth has been able to help you resolve some feelings from DD's birth? It must have been amazing and very special for you to see him born