Anyone had an induction after previous caesarean? My ob says it's dangerous but I don't want another c/s if poss.

[Lemele]

I had a planned c/s with my first (am diabetic, he was a huge baby). Needless to say I would like a natural (vaginal) birth this time if at all possible. I'm having twins and there is no reason that I can see for having a 2nd c/s (they are not large babies, they are both head down, etc) except that the docs agree it's safest to get them out by 37 weeks due to various risks connected to both diabetes and monochorionic twins. So I'm thinking, okay - induction then.

However my obstetrician says that the drugs used for an induction can cause problems with my previous c/s scar (internal bleeding etc) and so unless I go into labour naturally before 37 weeks she says I need a c/s. While this sounds like it makes sense, I have spoken to friends who had a c/s and then an induction recommended to them for the following baby (this is at the same hospital).

So does anyone have any experience of this, or are there any docs/midwives who can give me advice?

I don't know really other than I had a c/s for DD1 because she was breech. I'm 39 weeks pregnant with DD2 and have been told that I can have a VBAC if I go into labour naturally, and if I go over my due date, they will break my waters if it's possible to do so. Otherwise, they won't offer any other induction (drip etc) because it's too strong and increases risk of uterine rupture.

I'm happy to accept that because my gut feeling is if I go over and am induced, I'll end up with a c/s anyway so may as well have a c/s without the labour beforehand. So I haven't tested how adamant they are with their 'no induction' rule. Not sure if I could insist or not.

Good luck!

I've not had a CS, but have had an induction.

If I had to make the choice this time round, I'd choose the CS over induction.

Induction increases the chance of EMCS anyway (as well as other intervention including operative vaginal delivery)

Of course, you could go over 37 weeks and ask for daily/every other day monitoring to check on the babies and then decide what to do if a problem comes up.

I'd suggest joining the Yahoo VBAC group, there's bound to be someone on there who has been in a similar position to you who might be able to give you some really good advice :)

Hi

My waters broke at 34 weeks and i was induced at 35 weeks. Was awful....laboured for 66 hours dilated 1 cm ended up with emcs due to DD heart stopping..
Now 34 weeks preg and have refused induction and have cs booked for 5th april
X

I have had an induction for my 3rd baby following an em c-s for 1st baby then VBAC following spontaneous onset of labour for second baby. The hospital I went to did not use pessaries for induction post-section, as once those drugs are in, you cannot stop their effects, IYSWIM. However, they did induce me for DD3 using a synto drip, as that drug is washed out of the body quickly, so they could stop the drip if there were problems and my body wouold clear the residual drug quickly. I was induced because DD3 had health issues that meant she was better out than in, so was induced at exactly 40 weeks.

There are increased risks for uterine rupture with the prostaglandin pessaries, and indeed, with any form of augmented labour. I don't know the exact figures but they'll be out there on Google. I had CFM with both my VBACs for this reason (though DD2 was not an augmented labour).

TBH, it seems to depend on your obs consultant - some will take the risk, some will not. And I was not having twins! Hope you can find someone who has more experience of your exact situation.

I was birth partner for a friend who had synto drip after previous emcs. When Dr put it in I asked about rupture risk amd he said it was 1 percent risk or something very low like that.

If I was you I would research methods of induction and risks.

I have a friend who has just given birth (i.e. no personal experience of either here) but her first was ELCS due to breech baby. The second was breech right til her CS date, but then turned. She ended up overdue and they induced her. Her gynae wouldn't give pessaries as apparently it's too uncontrollable, but she was put on a drip. She was also told she would only be allowed to labour for a certain length of time before being given a section. She ended up with a section as she didn't progress.

(I'm probably wrong on this but I think I read somewhere it also depends on the type of CS you had as apparently there are different ways of them doing the cut.)

If you go for induction, then yourpossible outcomes, in increasing order of desirability are
A) uterine rupture. Risk normally quoted as 1%. If that happens the obstetricians will whisk you into surgery and you'll probably all be fine, but it would be immensely traumatic, and there is a noticeable risk of irreperable damage to one of you.
B) you labour for a day in immense pain followed by an EMCS. Having done this, it really sucks, and gets your life as a new mother off to the worst possible start. Odds vary but with twins maybe higher than average (?) - anything between 25% and 50%.
C) all goes well, normal labour followed by vaginal or forceps delivery - odds somewhere between 49% and 75% - so the most likely outcome.

I had VBAC and I personally decided that 1% chance of rupture was not a risk I was prepared to take - if I went overdue I'd go straight for ELCS. In the end I went into labour on my due date and delivered with forceps - it was fine. A friend of mine with a prior caesarean was induced by her hospital, I was at the risk, but of course she didn't rupture, although she did end up with an EMCS.

Personally in your situation I'd go ELCS if you get to 37 weeks, partly because of the high risk that you'll end up with an EMCS anyway, but induction is not a crazy choice. Best of luck for the rest of your pg.

Hmmm I realise my experience is not standard but after enduring a 70 hour induction with a failed epidural and ventouse delivery that left me with so many stitches I couldn't sit down or walk for 6 weeks I think I'd rather the c section!! (Which is what I'm fighting for this time around!)

There is a load of useful data here vbacfacts.com/vbac/

Thanks all. I've been doing some research as well but wanted to hear some personal stories/opinions. I had a hospital app today and actually my ob was much more open than she has been previously - she actually told me a lot more about several things I'd been asking about for a couple of months now, and for the first time made it clear that it was a choice (but that she would obviously personally recommend the c/s). And she told me some reasons for a change, statistics and the like (often when I've pushed for reasons for doing certain things, she wouldn't give me a clear answer, or would answer without any specifics). To be honest I still get the impression that she expects me to go into labour early - which is obviously the ideal! Bizarrely if this happens and I still end up needing a c/s I think I'll be a lot less bothered because I know it'll be for a life-saving reason that is happening right then and there.

Overall I'm already feeling a bit better about it but am going to do more reading and have more of a think about whether I'm prepared to take the risks which are associated with the VBAC.

Any more opinions are welcome!

Hi Lemele,
I had an appointment with what is called a PBAC clinic (positive birth after caesarian - bleugh) yesterday and discussed this with the registrar there. My situation is somewhat different, having a singleton pregnancy, but because I have developed gestational diabetes and my previous baby was on the big side (although not through g.d.), there is quite a likely scenario that the OB will start recommending induction for me at around 37-39 weeks if no spontaneous onset of labour.

For you, I'd be quite surprised if spontaneous labour didn't begin sometime around 37 weeks anyway - that's the average gestation for twins isn't it? Although I guess with averages, there are always the ones outlying on either side.

At my hospital, the method of induction for a VBAC would be to use a Foley catheter to ripen and encourage dilation of the cervix to 2-3 cms. This is a catheter with a balloon attached that is inserted into the cervix and then the balloon is inflated, which slowly causes the cervix to dilate. It takes a while but is considered to be safer and just as effective as hormonal gel. here's a link

The next stage if labour hasn't started at this point, would be artificial rupture of membranes - i.e. they'd break my waters. I guess they could also do a vigorous 'sweep' to strip membranes before actually breaking them.

I think ARM can be enough to start labour, certainly a big % of women whose waters go spontaneously are in labour with 24 hours (those that don't are generally asked to go in for induction!) but once it's done the clock does seem to start ticking.

The registrar did say that if labour didn't start after ARM, then there is the possibility of using syntocin to start contractions, it would require continuous fetal monitoring and the amount would need to be carefully controlled as this is something that can increase the likelihood of uterine rupture.

Perhaps you could go back to your next appointment and ask whether these methods of induction could be used first. If they're not familiar with them there may be resistance but equally they could be interested in trying it out.

My feeling was that if I didn't go into labour spontaneously after the first two processes, I'm not sure I'd want to go down the syntocin route as it was most likely to mean my body simply wasn't ready and I'd be in for a long haul, less mobile (because of monitoring and probably epidural) and increased likelihood of distress/failure to progress leading to another emergency c-section. So I think I'd probably elect at that stage for a c-section over introduction of syntocin.

Having said all that (and I apologise for the essay-length post), I'm going to be very much wait-and-see regarding induction anyway, my control of my blood sugars has been good and I think that should reduce the pressure to induce early as a standard protocol for me. I may well insist on an exam to check my body's 'readiness' (Bishops score?) before agreeing and also ask for several sweeps before anything else. I can't really see the point in even getting started on induction if there's no indication in my body that things are gearing up for it even slightly.

Good luck with your decisions - and with the twins when they arrive however that is. I can not even imagine what it feels like to have all those limbs inside