Induction after caesarean??????

[Lolly]

Hello

We are planning to TTC in June this year for bub number two. DS was induced and born by emergency caesarean due to complications with Obstetric Cholestasis. I was so hoping for the natural birth with him but it wasn?t meant to be. I have done my research and I know that there is a very high chance of me getting this condition again with the next pregnancy and if that is the case the baby would have to be born at around 36weeks. The obtestation told me after I had DS that I would never have a VBAC if the condition reappears and surgery would be my only option because they will not induce if you have previously had a caesarean.

Is this the case? Does anyone know if you can be induced after having a caesarean section.

Any advice would be great

Lolly

[BellyBelly]

You wont be induced with any medication as it increases the risk of rupture. The only thing some will use to induce VBAC women are foley's catheter or a balloon induction if your cervix is open. The basically blow up the balloon in increments to help open your cervix.

[Astrid]

The reason they do not induce when you are going for a VBAC or as they sometimes call it, Trail of Scar, is that there is increased chance of uterine rupture due to the scar. The risk of this happening is much greater when you are induced rather than if you were to go into labour naturally.

[Lolly]

Thanks Ladies,

I have done a little research and found the same thing. I was just hoping that you knew something I didn't. Oh well just have to accept that it will be another CS for me unless it happens by itself at just the right time. Not hopefull but better to have a healthy baby and mum.

Lolly

[BellyBelly]

Its okat to grieve if you aren't able to have a vaginal birth, caesarean is much safer than a uterine rupture - if you rupture they may not be able to repair your uterus. But don't feel that all that matters is the baby, you matter too, so it's okay to feel sad, disappointed etc, hopefully you can have some good support around you to encourage to talk about how you feel without being insensitive. The birth de-brief forums are good for that too, we make sure that it's as supportive as possible for you no matter how you feel. You are important too, everyone will do what is safest and know it needs to be done, so we need to nurture mums' feelings too.

[didispunk]

Will they give you any type of meds for induction at all?? And how long will they let you go over? normally?

[krisp]

Dear Lolly, I had an emergencty CS with my DS and was desperate for a VBAC with my DD. I was told by others that I wouldn't be 'allowed' to go over my due date but my OB said she was comfortable waiting, I was also told that I couldn't be induced by my OB said whilst she wouldn't induce via the gel she was comfortable rupturing my membranes and trying a drip. Luckily I went in labour myself 1 week overdue and achieved my VBAC after 8 hours in labour. Do your homework, find an OB who is very pro VBAC and take each week as it comes. Most importantly if you end up having another CS try not to be too hard on yourself, the safety of your baby and you are the most important things to consider and if that means another CS then thats perfectly OK.

[Lolly]

Thanks for your support. Unfortunately I will not have the opportunity to go over due. When you have OC your baby needs to be born at 36 weeks do to increased risk to baby after this time. There is no way they will let me even get close to term.

Just have to wait and see. Spoke to an OB about it last week and he said that there is a 50% chance of me getting OC again so those are better odd than I was working with. I was originally told 70% so fingers crossed that I won't get it. But I am prepared for it just in case.

[jessica]

HI Lolly, I have just read your posts on this topic over a couple of months. I was happy to read of someone who will understand my situation.
I have been pretty stressed the last few months.
I had OC with my first born son & he was delivered by c-section at 35 wks 5 days, healthy.
Now I am 33 weeks pregnant & have been terrified about OC but so far no symptoms.
I have been hoping for a VBAC if I don't develop OC but now the Ob tells me this baby is very big & because I can't be induced my chances of VBAC are 50% or less.
He said he will let me get to the due date & if no labour it will be c-section as baby will be too big to deliver naturally.
I have had one blood test & liver function was on the higher scale of normal. I had another test last week & ob will ring me if it has become high so I am also worried about that. I don't feel itchy, just a bit 'tingly' if i get hot but i have alot of trouble sleeping so fingers crossed its not the start of OC.
Are you now pregnant or still planning?

[krisp]

I also had a CS with my DS. With my second bub my wonderful OB did not at any stage mention a CS was necessary, she did not tell me I couldn't go overdue, she did not tell me that I would only have a limited time to deliver, she did not tell me I couldn't be induced.
I went a week over, she was willing to break my water AND use the drip to induce me if necessary to acheive my VBAC.
What she would not do was: induce me with the gel (cannot control it like the drip), allow me to keep pushing after 2 hours when my precious bub went into serious distress. Even then though she did not mention the "C" word.
She instead talked me through my best chance for a VBAC and then with my permission she called for an anaethetist (sp?), arranged an epidural, helped my baby girl out with forceps and then when she knew my little girl was OK (she was very flat when she arrived and was actually given O2 to kick start her breathing), she spent over half an hour stiching me very carefully, and then instructed the midwives to leave us alone to bond and get to know each other.
I had a very traumatic CS with my DS and she knew how important this (my last) birth experience was to me. Both to heal my trauma with my first go and to experience my baby under my terms.
She was an angel and I would recommend her to anyone and everyone. I shout her name from the roof tops on this forum because she is worth her weight in gold and then some!
If you are interested it's Danielle Wilkins at Clayton (Melbourne). I think she is due to have her baby soon though so she'll be off for a while- sorry!

[Lolly]

Hi Jessica

We are not pregnant yet but are having a good go at it. Maybe this cycle will be our turn.

How far along were you in your last pregnancy when the symptoms showed up? It is so scary isn?t it? I absolutely hated pregnancy last time and have every thing crossed that this one will be different.

I had symptoms from about the 7 month mark but I just thought it was bizarre normal pregnancy symptoms so just ignored it. I got to about 38 weeks before the symptoms got really bad and couldn?t cope any more and I called the hospital. They told me that I was reading to many books and made me really doubt myself and feel so stupid. My son was born at 39+1 when I finally found a Dr who would listen to me and did the test. It didn?t help that I had only moved into the area at about 8 months so didn?t have a GP that I could talk to at the time.

This time around I will know better and not allow them to dismiss me like last time.

I?m afraid I don?t know much about VBAC?s with big baby?s maybe you should ask someone in the VBAC support thread. How big do they think your baby is?

What colour are your bowel motions and urine? After the itchy hands and feet that was the next thing I noticed that was odd?

Did you get really bad Morning Sickness with this pregnancy? My OB told me that if you are disposed to OC and get really bad MS than you can be pretty sure that you will develop OC. Something to do with the placenta being really officiant and producing lots of pregnancy hormones which make you sick. These hormones also put your liver under stress trying to process them towards the end of your pregnancy.

There is a great site if you go to Google and type in Itchy Mom?s. You hopefully will get a lot of your questions answered there.

Good Luck Jessica

I hope everything goes smoothly for you.

[jessica]

Thank you for your responses ladies.
Firstly Krisp, how did you recover after the epidural & forceps? I am curious about this as an alternative to c-section. So, did the ob say, stop pushing & do the epi & forceps? Did you have an episiotomy as well? You see, these things scare me ATM probably more than a c-section which might sound odd to some but its because i haven't felt a contraction, or pushed or felt anything related to labour as mine was planned last time so early. I guess a c-section is familiar so i think, oh it must be better.

What I do feel sad about is not getting to see my baby naked & still attached to the umbilical cord etc, not all wrapped up & then only for 30 seconds before being whisked away for hours. Of course at the time it was a blessing just that he was alive as i was told he could die anytime so i wasn't worried about the birth at all. It's just afterwards thinking what i missed out on seeing, i haven't even seen what a placenta looks like.

So now i am just as scared about natural labour as i would've been the first time if i had got that far. The horror stories scare me alot & the thought of my vagina being cut is just horrible, so i am just wondering if you were worried about that at all? I guess you wanted the experience of birth after your first one as well.

i have been reading about VBAC & big babies & alot of women say its no different & you don't know until you try, its more about being active in labour etc.
This baby is estimated to be 9 or 10 pounds so very big & my ob says its ok to try but be aware that your chance is only 50%. I just feel confused as to why he tells me this, is it easier for him to do a c-section or is he really going by his experience & the probs women have had with big babies??? Am i being naive to not listen to him, he's the one whose seen bad situations not me?? Sorry lots of questions, my mind is buzzing right now.

Lolly, with my last pregnancy I don't have a record of the first symptoms as, like you, i had no idea why I was so itchy. I can guess it was around 28-29 weeks or maybe mild earlier than that. But it was unbearable by 33 weeks & at 34 wks i had insomnia, as in not sleeping ALL night from itching. I can't believe you lasted so long, you are very lucky your baby made it.

That's why i have been wondering this time & kind of waiting for it to start, every itch i get i think, oh no this is it!! I was beginning to think i am so lucky until the ob said the bloods showed liver function in higher end of normal. I am now 33 weeks.
Yes last time i had very pale stools & dark urine. Now they seem normal, maybe stools a bit light. In the end i also lost a few kilos as i completely lost my appetite. So for me going to hospital at 35 weeks was a blessing & my ob took it very seriously, he even had a specialist physician see me to get his opinion. It was nice & cool there & i was more relaxed, ate good meals i didn't have to prepare etc.
At 35 wks 3 days it was decided to do c-section in 2 days time as every blood test came back higher than the one before.
I was glad I could afford to go private as the local GP in our small town (i had shared care) told me that there is a liver condition but its very rare so didn't bother to even do the blood test. Luckily i was going a week later to the ob who had a different attitude.
So, i am keeping my fingers crossed the OC doesn't come on suddenly, which i still expect to happen, maybe i am a pessimist??
Good luck with falling pregnant.

[krisp]

The recovery was ok. I had terrible hemmoroids and then pushing for 2 hours made them really bad! Yes the OB said OK that's enough, my DD hadn't budged an inch. She was posterior as well which didn't help. The Dr said we can try a manual turn and a forceps assisted delivery and if that doesn't work then we'll talk about our remaining options. I knew she meant a CS would be necessary but she didn't say it, I suppose she wanted to leave it as long as possible. So I had the epi, she turned Paisley while she was still inside me and then as I pushed she pulled. I didn't have an episiotomy but did tear. Her stitching work was from what the nurses say excellent. I do have to admit I still have "issues" down there but its more to do with my bottom and my nasty hemmoiroids than my vaginal delivery sorry - TMI!!!
I wanted to avoid the CS for many reasons. An important one was my little man at home. He was only 19 months old when his little sister arrived and another CS meant I wouln't be able to pick him up and care for him as well (lifting in and out of his cot etc). For me it was the right choice, but a VBAC isn't necessarily right for everyone. Do what you feel is right for you not what other people tell you to.
Good luck, take care OK.

[Lolly]

I had pushed for an hour before I was taken to theatre. Like krisp I also ended up with bad haemorrhoids. I had never had them before so don?t know what is bad or not but they were the most painful part of my entire birthing experience. I kid you not, they gave me morphine for my CS but I wasn?t even bothered by that wound. I was pushing the morphine for the haemorrhoids. They were horrible.

Good luck I will be thinking about you.

[didispunk]

Lolly.. my doc will induce with drip but no gel if needed..

[Beach Mama]

Didi - check out this link hun. HERE check point 3.5 all studies show there is a definite heightened risk of rupture if you are medically induced - up to 15 times in some cases which is significant. Has your Dr talked to you about those risks?? Don't want to throw you off but I just find it interesting that they will be doing something that has proven increased risks without talking to you about it- or maybe they have and I've missed a post somewhere - sorry! Ive heard a Foley catheter can be used but not drugs.

[didispunk]

Thansk tan..
ya MW and Doc have been over it with me.. if need be.. But after reading Silent Knife.. plenty have been induced with very very mild amount of drugs... I will cross that bridge if i get to it.. but at least know the options and risks involved..

Anything to stay away from C-sec.. with still minor risks.. i am comfortable with..

[BellyBelly]

Anything to stay away from C-sec.. with still minor risks.. i am comfortable with..

Induction is a major player in cesareans, because your body isn't ready, your baby isn't ready and babies don't like it. Given it's your second and if you have to be induced with OC, I would opt for the rupture of waters at first instance. You can use EPO to help soften your cervix prior to, internally and orally. You can have acupuncture during your pregnancy, weeks before your due date..... But if you want to avoid a c/s... induction with the gel or drip should be last options.