Advice needed on induction after previous c-section

[Beeper]

Hi I am now 40+1 according to scanning dates but I am 40+6 according to my own dates.

MW said yesterday to come and see her next thursday which would make me well over 41 weeks by my dates and over 41 weeks by scan dates.

She said if I had not gone into labour by then she would book me in for a sweep two days later and then if nothing a induction two days after that. This seems like a very long time to me, and I am a little worried.

Also she said they would use syntocin and I hear thats not good for a potential VBAC.

Should I start making unhappy noises now or is it safe to go over that long.

Please advise

Hi - not sure about where you are but my hospital has a policy of no inductions at all after a c-section. They actively encourage VBAC but refuse to use anything other than breaking waters - I was told they've stopped in the last year using syntocin as the results tended to end up in another c-section. I'd go back and ask....just so your mind's at rest.

I did a fair amount of research into induction when I sailed past 40wks, and decided it was not for me.

I had my first attempt at a sweep at 41wks but they couldn't reach, had another at 41+5 but could barely reach then either

I cancelled induction booked for 42wks, had a sweep which showed me to be 2cms with a Bishops score of 8 and had my VBAC at 42+1.

I did have dates discrepancy to back me up so that I actually gave birth at 40+6 lmp rather than 42+1 scan.

However, was fully confident that Expectant Management from 42+1 was reasonable and making sure that I was treated as an individual rather than stuck on a conveyor belt according to arbitrary dates.

Yes the risks of stillbirth rise, but these risks are still tiny and should be considered in context. The risk of UR is not good, the risk of needing a CS because of failed induction is not good. You need to decide which risks YOU are willing to take, so maybe you need to ask mw to go over all the risks in depth so that you can make an informed decision. Don't be fobbed off with any wishy washy answers.

This mnemonic may be useful when weighing up pros and cons of induction against waiting with expectant management

BRAIN

B What are the Benefits to me or to my Baby?
R What are the Risks?
A Are there any Alternative courses of action?
I Ask yourself - what is my Intuition?
N Must it happen right Now...can we wait? Or is Never OK?

Thanks Klaw.

I gad a c section with dc1 and was induced at 19 days after with dc2. I had a pessary and was told they would only giv eit one shot. Luckily it worked. With dc3 i went into spontaneous labour at 21 days post due date. I had very regular scans after 2 wks pver and on both occasions they were very happy with the babies condition which is why i was happy to wait for natural labour with dc3. Neither looked late but scan dates were consistent wityh my dates. Trust your insincts.

thanks numpty

Should prob add that although i trusted my instincts and was very clear with my consultant that i wanted to go as long as possible i also made it clear that i would also be led by tyhem and if they said they really weren't happy i would do what ever. Perhaps that helped them trust me iyswim?

I gave birth last week 17 mths after a c-section. I went in at +12 for an induction after 2 failed sweeps. Luckily I had a show just before I turned up at hospital. When I did arrive they put me on the monitor for 1 hour only to realise I was having contractions (mild ones!) and I was 2 cm. Therefore the doctor didn't want to induce me for that reason. The plan was to leave me overnight and if nothing happened they would break my waters.
Luckily after a bath at midnight (with half a bottle of Clary Sage in!) not sure if it worked but 5 mins later my waters broke.
After a long labour now 12 pm they decided to give me a small dose (I think 10 ml) of syntocin to get my labour moving as I really wanted a vbac which seemed to work and my 12.30 I was ready to push!!!
I think you have to trust the doctors to do what is best for you. At the time I was aware that my cervix had slightly swollen and I knew because of this I might end up with another c-section which I didn't want. I was attached to the monitor (At times I took off and I was able to sit and stand by the end of the bed)
The doctors had my best interest at heart and did what they thought was best to avoid another c-section. So obviously go with your instincts but do what is right at the time for you at the time!! good luck!!

thanks vicky11 and congratulations

Beeper, I am amazed that they are suggesting inducing, it is not advisable to induce after a section as the extra stress on the uterus will exacerbate the chance of uterine rupture, please don't agree to it.

FWIW I went to 42+3 with my second vba2c, and gave birth naturally to a very bonny baby

my first vba2c and my 2nd section were 11 and 10 days late respectively.

Why not follow the advice from Klaw re BRAIN?

A average pregnancy lasts between 37 and 42 weeks, so at 41 weeks you are still in the realms of average, 40 weeks is not set in stone, some people take longer, some less time to make a baby, me I take longer and it seems you do too

Syntocin and cytotec are the two most dangerous things to be given during a VBAC - both are known to quadruple the risks of uterine rupture. So say NO or 'bog off' works just as well.

Spoke to the mat unit today and they said they would only give me one dose of a pessary and not syntocinon. I know this poses a increased risk also.

I am going in for a sweep next friday when I will be 41+3 and then in for a 'possible' induction on sunday, if I decide to have one.

I hope I go into labour myself I did last time, I am gonna give anything ago, although not the swollow.

Thanks ladies

'I think you have to trust the doctors to do what is best for you.' Sorry Vicky11, that's not what many women believe after being at the receiving end... sadly. I'm afraid that that's a fairly naive thought, with as much gentleness and respect as I can. I am so pleased you got your VBAC, the high will last you a lifetime!

Women should trust their own bodies more and believe that they can birth their own babies. We need to take charge, ask questions, make informed decisions.

What's the difference between God and an obstetrician?

God knows he's not an obstetrician!

Do NOT let anyone induce you.strongly increases risks of scar rupture.I tried for a VBAC and all the experienced midwives (and consultants too)agreed on this.I ended up with another section but it was still great ,i had all the lovely labour hormones and I was so happy to have tried,and then the section is so much easier to take when you have been through it before.Wishing you luck for the birth however it ends up!

Nothing really to add to what's already been said here. I did a lot of research when I had my VBAC (6 years ago now) and decided that the risks of induction were too high. Consultant agreed that I could go to 42 weeks without them hassling me, but at that point I'd have another elective section. Luckily it didn't arise - I had dd2 at 38 weeks +5.

Good luck

Thanks Ladies,

My DH and I have decided that the risks of induction are to great. I am going to ring the consultant on Tuesday and try to book a section if nothing has happend by next sunday.

I feel that I just can not go through a labour that is started artificially relaxed enough for my body to work properly.

Thanks

Hi Beeper
I've done some research into this too, as am 35 weeks with my 3rd, and went 17 days over with my second, gave in to pressure from hospital and had a CS. Baby was covered in vernix, clearly not at all post-mature, and I hamorrhaged horribly during operation, needing a transfusion afterwards. SO, I am very keen to avoid another unnecessary section this time, just because I have gone past 42 weeks (if I do, which i really hope I don't!!)

The risks of stillbirth due to long gestation are tiny... up from 1 in 1000 before 42 weeks, to 2 in 1000 after 42 weeks. The research these statistics is very old - nearly 30 years, and many researchers now believe that due to better antenatal screening, earlier diagnosis of babies with problems etc, that these figures are very likely to be lower now. Babies with IUGR (intrauterine growth restriction) ie small for dates babies, are more at risk, however.

As long as your placenta is healthy, and the liquor volume around the baby is adequate, it is safe to continue your pg until baby is ready to come out of its own accord.

A slightly off-field suggestion, but have you considered speaking to an acupuncturist and seeing if they might be able to get things moving in a gentler way? Just a thought - and I quite appreciate that many people might consider it a load of mumbo-jumbo - but if I was concerned about being induced by the hospital, I would probably go for acupuncture to see if labour might be stimulated in a more natural way.

Good luck with whatever you decide. I am sure whatever your instincts are telling you will be right for you.

Am a bit puzzled here so bear with me.........has no one suggested expectant management to you? Just because you're "overdue" this doesn't mean you have to be induced OR agree to an elective CS. You could have scans every couple of days to check your placenta, water levels, general well being of baby etc.
Or am I being overly simplistic?
Your best chance of VBAC is to let nature take its course. No one is pregnant forever!

Beeper - I think it is good to avoid induction and think that Klaw's approach is a good one. Remember that 42 weeks is not an abnormal length of pregnancy in the Western world so make sure you give your body plenty of time for spontaneous labour before a repeat CS decison. Good luck.

I was told induction was unsafe - I could opt for an ARM if my cervix was favourable & head well applied but no synto or prostin - prostin is especially dangerous after a section.

Right then Beeper, have a look at Natural Induction methods. Personally, after researching again and again, I would consider relaxation, walking, sex and nipple stimulation above all other methods. Because you are using your own hormones, or those of your partner's. I might consider accupuncture at a push.

You'd have to eat a shed load of pineapple to get enough enzymes to make any kind of difference, but if you like pineapple and find it refreshing enjoy it for what it is. Castor oil? I won't even go there.

And this is a HUGE caveat - please don't try too hard! If baby is not ready to come even the most natural methods can stimulate false contractions that never become regular, tail off and leave you exhausted. Make sure that every night for the next week you are in bed early. Have a nice soak in bath or stand/sit in shower with water hitting your lower back. Get dh to give you a lovely all over massage, use almond or olive oil with a few drops of lavender. Keep warm and dim the lights in the evening. Eat little and often, keep your fluid levels up but also pee regular.

Let us know how you're getting on

Also remember that even if it comes to next Sunday you can still change your mind and opt for Expectant Management. Your HCPs should really have offered this as an option, as VBACQueen1 says.

I wasn't allowed induction at my hospital, they flat out refused.
I would have been able to have expectant management if I could've waited that long!
Personally I wouldn't do it, I'd do as Klaw said and use natural idnuction if possible, from what I know on my antenatal thread most people have gone into labour after acupuncture or a sweep, can you not get your mw to do a sweep? If your favourable enough for induction to work well and not take forever a sweep should be easily achievable.
Good Luck

AS a midwife I am worried about sweeps being thought of as simple means of getting into labour and more and more women are being offered them. They are however, IMO, an unnecessary intervention. They often cause bleeding and cramping which frightens and exhausts women prompting them to seek hospital admission. Once in hospital, more interention is likely.

Have faith that labour will start when nature is good and ready

But preferable to other means of induction possibly mears? Especially when past term?
(Tis a question, not a statement btw)

I'm with Mears. I frequently post about the risks of induction, as I fear people think it's a fairly innocent procedure. How many women are told of the downsides when being 'offered' a sweep?

Indeed, in my desperation for VBAC, and before I know what I know now, I accepted 3 tries at it. With hindsight and more education about childbirth I would never bother with one again.

The only pros I can think of is that it may prompt a labour that was likely to start in the next 24 to 48 hours anyway. So in that case why not wait? If a sweep is performed and a Bishops Score of 8 or more is recorded then you should know that labour is imminent, it should give you confidence to wait. But at what cost?

Risk of infection
discomfort/PAIN
demoralisation if unable to be performed
demoralisation if nothing happens even if successfully performed
accidently breaking the waters and so setting the clock

'But preferable to other means of induction possibly mears? Especially when past term?' well that was how I looked at it at the time, but not now. Term is classed as between 37 and 42 weeks so why all the jumpiness when women go past 41 wks? Why is Expectant Management not given more as a valid option?

A sweep is an intervention, and so should be considered very carefully. If there are no valid medical reasons to get baby born, if baby is still considered happy, safe and well inside mum why are so many women being induced just because of dates? Why are they not given a blardy good check up and decisions made based on their individual circumstances? We are not robots trundling past on a conveyor belt...

This is all my personal opinion, although I'm not alone, but I just wish more women had the chance, or took the chance, to make informed decisions for themselves... even though I may disagree with some of the decisions they might make.