VBAC induction 35 weeks ICP

[CustardCream31]

I think I’m after a hand hold/reassurance 🙃😢

Been advised to induce at 35+2 next week due to bile acids reaching 94…. HOWEVER, I’m leaning towards advocating for a 36+ week induction to allow an extra week of her “cooking”. The medical papers (including various NHS trust papers) say induction at my levels around 36/37 weeks, as there isn’t a significant increase in risk for stillbirth until that point unless bile over 100. I’ve not yet managed to speak to my consultant, and it was an unknown doctor who called me today to try and book induction for next week (I declined and said I want to speak to my consultant first). I’ve requested she calls me before I make a decision.

I was induced at 37 weeks several years ago due to dodgy LFTs (not ICP), and it was an awful 5 days of induction/labour/contractions, and then resulted in an EMCS at 10cm…. Then a further 10 days-ish in hospital due to me and baby getting an infection (he was distressed due to hyper contracting from the drip being too high) and passed meconium during labour. I was really really traumatised by this for so long after. And still am…. Think this is instilling further fear in me for this induction. I think I’m set on a VBAC attempt rather than elective c section because my recovery from surgery is so poor and slow.

Anyway. Waffle waffle. Can anyone give any enlightenment/reassurance for a 35/36 week VBAC induction? How did it go for you? Would rather positive stories only at the moment due to wanting to try and be positive in my head about all this. Was NICU time needed? What gestation/weight did your baby get to? I’m so upset and worried about her needing NICU time.

Thanks so much in advance.

Hi, I had an induction at 37+5 with my second child due to very high bile acids (I can’t remember the exactly number) it was an awful experience and I ended up with a 3rd degree tear and a painful recovery. With my third I had a planned c section at exactly 37 weeks even though my bile acids were slightly lower it was very calm and recovery was much easier. When the consultant looked back I had raised LFTs with my first which they believe was the beginnings of icp as the LFTs tend to rise before the bile acids. Have you contacted icp support they have a website and also a Facebook page, they helped me advocate for myself and baby and also have professionals for advice. I also moved to a larger hospital that got the blood test results back within 2 hours which was a big help. Good luck x

I know you're looking for positive experiences but statistically speaking, induction at 35 or 36 weeks is not likely to work.

I'm sorry your bile acids have gone up again.
As soon as mine went over 80 they induced straight away
I was a bit further along an 36+6 when they did the sweep and they said they were optimistic i would respond. They repeated my levels and as they hadn't increased further and there were no beds for induction that day they left me to the next day. The sweep gave me regular contractions although I had been having them on and off since 33 weeks and they did wonder if I would need the induction at all
Everyone was concerned about me having the strength for an induction and because I also had low platelets I wouldn't have been able to have an epidural. We made the decision that we would try an induction but had a low threshold for stopping and going to a c section. As it was it was 20h from initial induction with 6h of active labour and I didn't have anything left. The last few hours I had to lie down and try to sleep between contractions.

I had the pessary in for only 4h and I knew I didn't have a several day induction process in me so had the first pessary not worked I wouldn't have any further ones. I also wouldn't have had the drip as I didn't have the strength for an intense induction process either.

So I think that is where I would start, what do you want to try and where would you draw the line.

Best of luck, you were really supportive when I was going through this x

Hi @Superscientist, thank you for messaging here too. Means a lot. Have been thinking of you.
it’s really positive to hear your experience (not so much the previous posters unhelpful input when I asked for a bit of positivity!!), and to try and help me manage expectations in my head.
Am booked for induction next Tuesday at 36+3, so we shall see! Will be balloon as can’t have pessary due to previous c section.
bile acids this week were 59. Have been yo to-ing up and down. But urso has definitely worked on my LFTs which have come down considerably from where they were.
Hope you and little one are recovered and settling well ☺️

@georgiamsthank you for your message too - great recommendation for ICP support page on Facebook - I had a look and loads of useful information and insights.

I'm glad your bile acids have calmed down and that the udca has stabilised your lfts.
I hope the induction goes ok. 36+3 is so close to term, especially by the time you've gone through the process. It was nearly a day and a half from deciding to induce me and starting the induction due to bed availability. The active labour with my daughter was only 2h so they didn't want to start the induction until they knew there would be a bed in the birthing suite for me.
Have you given much thought to your red lines for induction and at what point it's probably not in your best interests to continue and a C-section would be a better path?

Thank you. Here’s hoping it’s quick and smooth 😆 we shall see.

hmm good question and consideration. I think if at any point she starts getting distressed in there. And if it starts rolling into 2-3 days of active labour (I did 5 days before and I was totally exhausted, as was baby who was distressed) and I absolutely don’t want that again. And if any warning signs of my scar rupturing… I want to try my best to have a successful vbac, but realistically I know I need to be fluid in my decisions.

can I ask what your red lines were? Any insight appreciated 🙂

It was mostly around time and conserving energy. Any prolonged induction or an induction that was intense and wouldn't permit me to be able to rest as I needed.
So I wouldn't have accepted multiple pessetry, I probably wouldn't have accepted the drip depending on the circumstances. If I was progressing slowly and it was going to look like it would be over several days or wasn't coping with the pain. As it was I had two dose of paracetamol whilst in the induction suite and only needed gas and air after that.

If baby had gone into distress or if they would be recommending an instrumental delivery would have been another thing I was wanting to avoid. My low platelets meant I was at risk of a hemorrhage so couldn't have an epidural and an episiotomy would have come with a risk of a serious bleed so I was wanting to avoid that. They were doing blood tests through the labour and induction to monitor my platelets and if they were dropping further.

Baby did go into distress right at the end. After my waters were broken labour had accelerated and I went from 5 to 8 cm in about 40 minutes with each contractions they lost his heartbeat and they were seconds away from pushing the emergency button 3 contractions in a row. They did an exam at this point and they were optimistic that I would be fully dilated and ready to push within minutes which I was and just about had the strength to get him out. If that exam has shown than wasn't close to to delivering I would have asked for a c section. With a midwife chasing him down my pelvis with the monitor on each contraction they were able to keep hold of his heartbeat with the contractions and see him recover quite quickly from deceleration. The head midwife was in the room until they were happy that he was coping well enough, I think at one point there were 4 midwives in the room!

I hope it goes ok tomorrow, how are you doing?

Morning @Superscientist. Thanks so much for thinking of me, means a lot. Well, she’s here! Born at 36+4 after a speedy VBAC induction! So happy. Although we are being kept in as she’s technically late preterm, and has jaundice (although not bad enough for light therapy, but needs bilirubin to reduce in her bloods).

sorry I didn’t reply sooner. Glad your labour went as well as it could despite hairy moments with distress at the end. I really hope you’re doing ok. Catching up on other threads I think we are in on together shortly too!! 3am feed and pumping right now lol.

Aww massive congratulations @CustardCream31 !! Well done you! No mean feat! Sounds like you didn’t get induced at 35+2 so well done for advocating for yourself! I was just coming on to give my positive induction story but now you have one of your own! I was going to say even though you’d had a long and difficult experience before, you had dilated to 10cm so your body knew how to do it, this usually helps with second time round and dilation happens more quickly as the uterus sort of remmeber show to contract better.

Also whilst your first Labour wasn’t as you would have liked it I wanted to reassure that all the things that didn’t go to plan were all things that could happen when you go into spontaneous Labour - I know many people that have ended up with a emergency c/s at 10 cm dilated who were never induced - often to do with baby being distressed / baby being too big and getting stuck. One of my friend had a normal delivery 1st baby and needed an emergency section second - every time she contracted the baby’s heart rate seemed to massively soo so they were worried but he came out completely fine and they think he was maybe squeezing on the umbilical cord with contractions which make it look like his heart rate was much lower. I say all this to say sometimes it’s luck of the draw.

In terms of long active phase, every place offering the drip for induction should offer adequate pain relief (epidural) - I was going to say accept this early. I had an epidural at around 6cm and I was so lucky that there was an anaesthetist able to put one in immediately (I know not the case for a lot of people) - this meant I got to sleep and rest. It’s a huge thing your body going through Labour and you need rest!

Finally I wanted to reassure everyone that at any point if baby is distressed / scar rupture the medical team will be wanting to get that baby out before you say boo to a goose!

Hope her jaundice settles soon!

Aww massive congratulations @CustardCream31 !! Well done you! No mean feat! Sounds like you didn’t get induced at 35+2 so well done for advocating for yourself! I was just coming on to give my positive induction story but now you have one of your own! I was going to say even though you’d had a long and difficult experience before, you had dilated to 10cm so your body knew how to do it, this usually helps with second time round and dilation happens more quickly as the uterus sort of remmeber show to contract better.

Also whilst your first Labour wasn’t as you would have liked it I wanted to reassure that all the things that didn’t go to plan were all things that could happen when you go into spontaneous Labour - I know many people that have ended up with a emergency c/s at 10 cm dilated who were never induced - often to do with baby being distressed / baby being too big and getting stuck. One of my friend had a normal delivery 1st baby and needed an emergency section second - every time she contracted the baby’s heart rate seemed to massively soo so they were worried but he came out completely fine and they think he was maybe squeezing on the umbilical cord with contractions which make it look like his heart rate was much lower. I say all this to say sometimes it’s luck of the draw.

In terms of long active phase, every place offering the drip for induction should offer adequate pain relief (epidural) - I was going to say accept this early. I had an epidural at around 6cm and I was so lucky that there was an anaesthetist able to put one in immediately (I know not the case for a lot of people) - this meant I got to sleep and rest. It’s a huge thing your body going through Labour and you need rest!

Finally I wanted to reassure everyone that at any point if baby is distressed / scar rupture the medical team will be wanting to get that baby out before you say boo to a goose!

Hope her jaundice settles soon!

Huge congratulations @CustardCream31

Congratulations! You did so well to get to 36+4. I hope the jaundice improves quickly and you can get home soon.

How are you feeling? X

Sorry, I’ve come out from under my initial newborn bubble rock now!!! she did need light therapy for a short while in the end but we are home now and settling.

Thank you so much for your congratulations 🥰 still feeling on cloud 9 that all went well!! My body certainly knew what to do this time…!

That's brilliant! Enjoy the newborn bubble!