VBACs and types of induction

[deliwoman1]

I'm only 20+3 today, but am trying to puzzle out whether a VBAC is a good move for me, or if I should just go for another ELCS (first was 2 years ago, due to breech). Obviously the baby will decide what happens! But I'm due at Christmas, so if I decide to go for an ELCS, I'd rather make that choice sooner rather than later so I can at least try and plan around it!

I'm curious about people's experiences of VBAC situations, particularly inductions. What was yours like?

I don't think I'd be offered the drip for a VBAC because of the pain and potential for scar rupture. Is the pain similarly intensified if you're induced whatever the method? I.e. with sweeps, rods, pessaries, gels, etc.?

I didn't labour with my first, and the VBAC seems to be a different ballgame altogether, so I'm clueless! Thanks for the help!

X-post in pregnancy

There's a lot of conflicting information about VBACs and induction but as far as I was able to work out, the only thing which is completely contraindicated is using prostaglandin pessaries to start labour. I think the reason for this is because sometimes they can cause very extreme contractions and once they're in that's it, whereas if the drip causes very strong contractions they can just turn it off.

My birth plan was to be induced at 41 weeks using a balloon catheter, followed by ARM and syntocinon if needed, and to have an epidural once in active labour. In the end I didn't need it because I had a sweep at 40 weeks and that did the trick on its own. I did have the epidural at about 3cm (very lightly dosed).

Thanks @MissScarletInTheBallroom, that's really helpful. Yes, I'm finding all the VBAC induction info a bit confusing!

I'm interested in the lighter-dose epidural too. How did that work for you? Were you still able to move or even walk with it?

I actually didn't put that to the test. My plan was to have a little nap and then get up and try to move around. But I went to sleep for an hour and a half and when the doctor came back I was fully dilated and ready to push! It was great.

But I think it was a lighter epidural than I had during my first (induced) labour which ended up in a C-section and I could walk and move around fine that time.

@MissScarletInTheBallroom Wow! That sounds ideal! Thank you for sharing. 😀It's so good to know that an epidural doesn't have to equal being confined to a bed!

It shouldn't have to mean that, no. But it's best to discuss it with the anaesthetist in advance so you know you're on the same page. Some hospitals do what they call "walking epidurals", but I'm not sure whether there is an actual difference between that and just a lightly dosed epidural.

I could still feel the contractions after mine but they were reduced to the same sort of intensity as mild period pain.

Obs anaesthetist.

Theres no such thing as a light epidural. An epidural is an epidural, they all use the same drugs. What makes it weaker is if you don't click the top-up button as often, they're patient controlled so you can give more as you feel pain..theoretically all epidurals are walking epidurals - I've never seen a patient in 10 yrs of labour ward walk with one though!

Most labour wards won't give oxytocin infusions for augmentation of labour in previous sections

You have little say in the date of elective sections just FYI re your planning comment, they're done as appropriate for clinical urgency and labour priorities

re the epidurals - they're all 'light dose' these days. The so called walking epidurals are 'even lighter dose' and not offered by a lot of hospitals for several reasons. Partly, for safety reasons epidurals need to be pretty protocolised to ensure there's limited chance to mix things up and overdosing people; a lot of women even with walking epidurals aren't able to walk (because the response to epidurals is very variable); the super light dose ones are light enough that they give rather variable pain relief and fairly often need top up doses of more concentrated anaesthetic which increases the chance of a denser motor block (the pain relief is even more variable than usual, and there is a significant amount of variability in the results with epidurals); not every hospital has the equipment to monitor babies whilst mobilising. By all means ask about them, but don't be 100% surprised if it turns out it's not available. The standard epidural is certainly lighter than they were historically and most women can move about in the bed a bit with a standard epidural. Worth noting that if you google walking epidurals a lot of American results that come up are referring to something completely different when they use the term and aren't relevant to UK practice.

I had an attempted vbac with the drip but it didn't work and I ended up having an emcs.

Hey VBAC here! Had a couple of sweeps, then had water's burst manually. Nothing happened so they fitted in an epidural & proceeded with a drip induction

Must have been one of these light epidurals as I could feel contractions. It was weird as I had a strange shaking reaction, especially if I pressed the top up button too much.

My maternity unit had 70% success rate on VBAC which I believe is a good rate so they had been keen for me to try it. Maybe you could ask for stats.

It was an amazing experience, I almost gave up at one point but pushed through til the end and was lucky to dilate on cue. Good luck.

Walking epidural mix is very much a UK thing. I've been an anaesthetist on labour ward in 8 hospitals. All epidurals are theoretically walking, with the aid of a midwife, but most people patient's labours are often prolonged enough to get heavy legs from prolonged administration and hence don't mobilse or don't want to. I've seen patients on all 4s or sat on a ball with an epidural, but it's certainly not common, and ive never seen anyone walk with one in obs, most labour sat upright in bed

If baby isn't breech - go for natural, 100% 😊 x

Shivering is a really common side effect, it occurs to many many patients (partially due to the vasodilation they induce), its sometimes dose related sometimes not. Occurs with pretty much all epidurals we top up for theatre as our theatre drugs are much stronger

I always tell mums epidurals are there to help with the pain of labour but won't ever eliminate it. They never numb to pressure or touch so you can often feel the contractions they're just not painful and it helps you know when to push

I attempted a vbac after first emc and they wouldn't use any form of induction due to rupture, currently pregnant with third and wanted a vba2c but the consultant has really put me off so I have an elective booked however if he came spontaneously before I'd go for a vaginal

@Destiny123 ah they didn't tell me it was common, just that it sometimes happens. I had a shivering spell that just went on for quite a while and it took a lot of breath work to get under control. That was the point I'd had enough but the midwife checked my dilation & urged me on.

I was actually really glad to feel the contractions and to just have them dulled or the edge taken off them, rather than being numbed. My friend said her epidural was so effective she could take a nap.

thanks - I'm also a UK obs anaesthetist. Have never worked in a unit that calls a standard (0.1ish% levo/bupiv) epidural as being 'walking' because most people can't properly walk with one and it's seems like mis-selling the product. In fact I don't think I've heard anyone call that a 'low dose' epidural for yonks because it's so well established as the normal labour epidural concentration (vs 25yrs or so ago when it would have been significantly lower dose than the older standard mixes). Most people I've worked with would be referring to 0.0625% as 'walking' and 0.1ish% as just 'an epidural'. Perhaps that's a regional thing and different where you've worked though. Not sure how many places here do 0.0625ish% epidurals for labour, but they are common in other countries (and they're so low dose that they seem to frequently need stronger top-ups because of inadequate pain relief). My comment re the USA patient info websites that come up easily on Google is that some seem to use CSE (proper CSE too, not a DPE) and walking epidural interchangeably and that is not standard here (or certainly not in any of the places I've worked) and could cause confusion to a patient exploring their options here. Hope that clarifies what I was thinking... apologies if it wasn't obvious from the first post.

Yeah 0.125 bupiv + 2mic/ml fentanyl bags are officially walking epidurals, it's on most of our epidural info card, but ive never seen anyone walk with one, the most being sitting on the ball or turning onto all 4s.

Obv somewhat depends on the units as to whether they go on mandatory bolus modes vs purely pcea as to whether theyll get a dense motor block. Maybe it's a southern hospial thing, I've only really worked in the south east/London

I've only ever used the above bag mix in labour and 20ml of the bag to load (was taught by a somewhat rogue sas to load a room epidural with 20 of 0.5% bup then leave the room but that obviously horrified every consultant when I changed trusts post ct1!

Yea Charlotte's in London is the only place I know of that CSEs everyone for labour it's def not the normal

Most can sleep with an epidural, hence why theyre so rewarding to do.I used to come back to check it was working, put my head in and just smile and leave if the woman was snoring - check complete

You may find your local hospital trust will have a set way they go about induction for trial of labour after a c-section. They wanted to induce me with my second at 38 weeks due to how large he was apparently going to be, and would only induce labour through breaking my waters if I was sufficiently dilated for that to happen. No balloon, no rods. I could have low dose pitocin if they could break my waters.

I’d have had more options at the hospital the next county over, and was considering a late change, but went into spontaneous labour at 36 weeks, so all became irrelevant. Got my VBAC though, and recovery was so much easier than after my EMCS, which was my main motivation for the VBAC.

I had a vbac a couple of years ago - same as you, my first was elcs for breech. I had 2 sweeps and went into labour naturally at 40+6. I had diamorphine as it was precipitous labour (my pain threshold is v low). I did also have a balloon induction (my trust doesn't do drips for vbacs) and an elcs booked for the week after, I couldn't decide what to do. It wasn't entirely straightforward, there was shoulder dystocia and deep 2nd degree tearing, but I was v pleased with the outcome and the recovery was a cakewalk compared to my elcs.

I didn't read it so much as picking an exact date, just about being able to plan around it better which is true.

I got my ELCS date a good 10 weeks beforehand (although as it happened it was brought forward as I got pre eclampsia) so could definitely make some plans around the date as opposed to going into spontaneous labour or waiting to be induced.

This time I'm having an ELCS again and I already know it'll be between 37 and 38 weeks unless something happens so I can semi plan again

I had a VBAC just 3 weeks ago, 26 months on from EMCS. It was very very tough to bare through pain as I'd been experiencing contractions for 3.5 days. VERY TOUGH. But the postpartum experience was miles better than CS, and delivery experience was powerful.

I was adamant I would avoid all forms of induction, barring a membrane sweep. I ended up giving birth day I was due to have my sweep, so didn't need in end.

I went to birthing centre which was an amazing experience. The midwives really empowered a and encouraged me, and really worked to see through my birthplan.

Clinicians will always try and steer you in a certain direction to cover their backs aligned with organisational policies. But ultimately it is your body, your choice, no one can make you do anything you don't want to.

They told me i couldn't go Birth centre but once i explained i was explained i was comfortable with the risks and being routinely examined they allowed it.

I avoided epidural because there was a risk they could slowdown contractions from relaxation. It did take me a while to dilate so i took other things to take the edge off paracetamol, codeine and methadone. And too much gas and air.

I was able to give birth in a birthing pooll which i had left off my plan but was something I always wanted. Discovered the reason I was innso much pain and struggling to dilate is because my waters simply would not break.

I could write an essay on my experience, but I'll end on this: you can do it. Good luck

Can I ask what they have really put you off about? I can't find much info about trying after two c sections.

Hey @other89 I have seen 2 consultants as wanted a second opinion they both said the similar but effectively it's to do with each individuals birth story and reason you had an emc. With my second I was 8cm and getting a burning / pulsing sensation right behind my scar which I could feel through epidural this correlated between babies heart rate dropping even before each new contraction turned out she had cord round her neck twice and when they operated my uterus's was paper thin so they said I was ok the brink of rupture but it was a 15 months gap so my body hadn't had much time to heal at all before getting pregnant again. Like I said if I go spontaneous before my date I'll be going for a vbac x

Thanks very much. I suppose it will just depend on my own hospital notes 😀