Induction after C section - anyone got any experience?

[CaribouMoo]

I am very confused by recent developments in my birth plan and would love some advice from anyone that's been in a similar position. 4 yrs ago I had DD by an elective section since she was breech. Since this baby has always been head down the plan was VBAC or another section if things didn't happen naturally. All along I was told that I could get membrane sweeps but no induction or waters being broken because of risk to section scar.

I'm currently 40+3 and at my check on Thursday I got a sweep but cervix only 1cm dliated, pelvic score of 3 and baby 4/5 engaged. MW called the hospital to ask for a section to be booked for Thursday/ Friday next week just in case nothing happens naturally, she was told there are no appts then its the weekend plus bank holiday - taking me to about 14 days over. So after speaking with my consultant they have all of a sudden decided its fine to induce me instead.

If that had always been the plan I would never have queried it but now I'm worried that they are allowing it as a last resort - just because there are no section slots. To confuse me further I spoke to one of the Mums at my daughter's nursery who is a MW at my hospital. She said she finds it very strange and thinks I should tell them upon arrival I'm not comfortable with the plan. She suggested also that the consultant on that day may even refuse to carry out the plan.

My notes say to try ARM if favourable (breaking waters?) and to give prostoglandin if not. I don't know how high the risk of rupture is, or the real threats to me or the baby. I'm assuming the wouldn't plan it if it is dangerous but am thrown but the sudden change of heart. I'm going to try and call my GP for advice on Monday but wondered if anyone has had a similar experience or advice in the meantime?

Hi there
Another option to throw into the mix is to wait a little longer and request daily monitoring and additional scans to check that the placenta is still doing its job properly. That way, your body still has a chance to go into labour when it's ready, rather than at the hospital's convenience.
Many of my mums (i'm a vbac coach) are under the impression that at 40 weeks, they have reached their due date, when in fact by World Health Org guidelines, a lady is not officially overdue until after 40 + 14. I do encourage them to consider waiting, if they are comfortable and aren't being subjected to scaremongering by their hospitals!
In terms of induction for a VBAC, this does vary by hospital. Some (indeed most) won't consider it for a VBAC mum, others do. What I will say is regardless of your previous birth experience, it is a sad fact that inductions will be highly medicalised and in many cases, end in Cesearean.
Please also consider that ARM is also a form of intervention. Whilst it's not the same as pumping you with hormones to bring on labour, the clock will start ticking once it's been done and you will definitely be strapped to a monitor, hindering your mobility.
My best advice is to do everything possible to bring on your labour naturally.
Go for lots of walks - gravity and movement are good.
If you can stomach it, oral sex (you to him!!!) and you have to swallow. The hormone in semen helps ripen the cervix and this in turn should get things started. The hormone is better absorbed thro the wall of the stomach than in your reproductive bits, which is why this is better than penetrative sex.

If you need any other help, please pm me.

Best

Mads
Antenatal teacher and VBAC coach
Bump to birth and beyond

I had a VBAC after an el CS for breech too. The risk of scar rupture is very low - less than 1%. Agree with what Bump said above. My waters broke but then labour didn't start by itself - I was 38 weeks - so was induced. Everything happened quickly after that -tho I did have a lot more intervention than I had hoped for, but I had my VBAC in the end. Good luck :)

Hospital where I work (as a m/w) we will ARM VBACS (if possible) to try and induce. Some consultants will allow syntocinon drip to be put up (with continuous monitoring) as this can easily be stopped is need be. Prostin is a big no where I am as once its in it can't be taken out.

Though I have heard that some hospitals are beginning to use it and I believe htere is some research now saying its not the risk that was first thought. I have actually given prostin to a VBAC woman once (didn't know she was VBAC AND dR had prescribed it). Her consultant was not impressed but she had a lovely normal birth a few hours later.

But its a long time till Friday so hopefully you will labour on your own before then. Can you get your midwife to do another stretch and sweep before then?

I've never seen any good evidence about oral sex being a good way to induce labour and if it was true about prostaglandin been betetr absorpbed in the stomach the we'd give prostin gel to IOL women orally instead of PV. I think its a bit of an old wives tale - I think straightforward sex is more likely to have an affect. Try some nipple twiddling (abt least 30mins worth) as that will help to stimulate oxytocin hormone.

Lol Viva! Nipple stimulation is good.

If you have an electronic breast pump, this is a good way to stimulate them, as an alternative to you or DP having a twiddle!!!

You could also consider reflexology or acupuncture.

I think the situation seems to be changing largely due to the cost of a c-section rather than new findings about safety of inducing a VBAC. I had assumed if I went overdue I would be offered a CS only to find I was being pressured into induction. Had appt with registrar at 41w at which I insisted I would not be induced. His arguement for why I should be was that they are under a lot of pressure from the PCT not to offer elective sections!! I pointed out that wasn't in my best interests. He also told me I shoudln't read the guidelines or statistics.

From the NICE guidelines, induction with prostaglandin results in 2.4% risk of rupture, which as far as I'm concerned is much too high. But using syntocinon and ARM without the prostin first is unlikely to lead to successful VBAC. That coupled with the fact that I haven't given birth naturally before (which lowers VBAC success) meant that I felt induction is not a safe or sensible method for me.

Ultimately if you refuse to be induced I think they will have to offer you a C-section albeit they may want to wait - my CS is scheduled for 42+2, which I'm happy with anyway as it gave me the longest opportunity of going into labour. But thankfully I had a sweep today (41+4) and am now in early labour!!

Best of luck.

Thanks very much for all your replies. They have booked me for another sweep on Thursday morning - but want me at the hospital by 8pm that evening. I wasn't sure that would be enough time to get things moving, sounds like it worked for you though Zimbah - all the best with your birth.

I've been keeping active, bouncing on ball, long walks, housework, pineapple, raspberry leaf tea, hot curry and clary sage. Looks like I might have to resort to sex too! I read about the nipple stimulation but it said you had to do it several times a day for an hour, who has time for that! I'll give it a try and feel ridiculous! You are all right though, ideally I would like this decision about induction to be taken away by going into labour without it.

I can't believe my consultant didn't go into detail about the risk of rupture - 2.4% is quite high. I've been given some other reading materials from friends which I will look over before I make a decision. Thanks again for replying.