Having braced myself to argue about vbac, now looks like I'll have to argue about induction. Is there any point, or should I just give in?

[phdlife]

Have been psyching myself up for vbac which I really really really wanted but hospital has been quite anti.

Now they have said, when I am 40+10 (Tuesday) we will have to negotiate a plan of action, because they do not want me getting to 42 weeks with double likelihood of stillbirth (tripled at 43 weeks).

I know I could argue for leaving it until 42 weeks to do anything - or longer, since double the rate of stillbirth is still only a tiny percentage - but I'm really starting to feel rubbish about the whole thing. Like I don't even want to do the research to argue with them, because I'm fecking tired (can't sleep - guess why not!) and I just want this baby out. Near as I can understand induction kills chances of vbac (please correct me if I'm wrong) but nothing we're trying at home is making slightest difference.

On the other hand I kinda feel as though even if labour started this minute I'd still probably end up having a section because I don't feel confident in hosp MWs/drs doing everything they can to ensure vbac (this may be unfair to MWs, who I've not met!) and even if they did, well, we don't know why ds didn't come out so what's to stop it going wrong again.

A doula is not an option; my MW sister is taking the hospital's line (she is too worried for me).

Come and talk some sense to me - though I have to go now!

Why is a doula not an option for you? if it's cost did you know you can get one for free through the Doula UK hardship fund? even if you didn't hire one I'm sure a local one would be happy to meet with you and chat this all through for a little bit for their time.

Anyway, back to your point. It's not up to you to do your research, it's up to them to provide you with evidence for their claims.

Due dates are a very inexact science. Naegle's rule (method of calculation) is well over 100 yrs old and has been proven in recent times to be inaccurate (ref. Mittendorf et al.) by between 4-8days depending on whether you've had children before. Remembering the WHO states normal gestation as 37-42wks you are not technically "overdue" until 42+1. Also if you have a longer menstrual cycle and don't ovulate on day 14 your due date will be incorrect (and early scans have error margins of 6 days either side).

Yes the rate of stillbirth increases but as you've correctly pointed out it is is tiny risk. Don't forget that inductions and C-Sections are not without risk, so it's about balance of risk of intervention with risk of remaining pregnant and birthing naturally. Ask your consultant if he/she can guarantee your baby will be fine and not stillborn if they induce at 40+10 (they cannot and will not!).

NICE guidelines state that if you refuse an offer of induction (which for a VBAC is tricky as prostin increases the chance of scar rupture so you have to have a fairly decent bishops score/be ready to move straight onto having your waters broken or synto - and some hospital don't induce with synto either!) then you should be offered expectant management (scans/CTGs) to ensure your baby is OK. No matter what is said to you, this IS an option for you.

I tend to find that VBAC ladies labour at around 41-42wks. I don't know whether it's something physical causing this (and it's not just me who has noticed it) or whether they perhaps have more anxiety/hurdles to jump, thus release adrenaline, thus inhibit oxytocin and thus inhibit the start of labour.

Have you had a sweep? (or two?)

The only thing I would add is DO do your research, things are far less frightening if you know what is happening so you can draw your own informed conclusion.

Sorry, can't help you with your questions about induction after vbac but just to say, Tuesday is a long way off and it could all kick off at any moment in the next 4 days.

There are loads of people on here who have VBAC's even though something didn't work out the first time. Think about them not about the 'what ifs?'.

I know its really wearing dealing with Dr's who sometimes only seem to see one side of the argument - esp when you're already worn out, but hang in there. Knowledge is power.

Think you should go and get on your hands and knees and scrub the floor, have a curry and a shag (if you can manage it)! If you don't go into labour at least you'll sleep...

Thanks, CCE - think you have hit the nail bang on the head. I have been vv stressed worrying about having to argue with every caregiver who comes into the room (I am not good at arguing!), and I reckon that is what's holding me up. Since reading your post last night I have tried to reframe my thinking about the caregivers - it's tricky since my appts are always with negative dr's rather than the MWs who'll be with me at the time! - but at least last night I was only awake for physical reasons, not fretting. Will continue to work on this one. (ps. NICE guidelines/doula fund don't apply here - I'm not in UK.)

They offered a sweep last week which I turned down as I was contracting all that day; it stopped later that night though. Have not wanted to go that route in case it broke waters (this is what dr seemed to be hoping would happen?) and put me on a timetable. Also they are talking about manual induction - putting a catheter with a small balloon into cervix... dunno what this procedure is called, do you?

MustHave - curry, shags, rl tea not making slightest bit of difference. But it is ds's birthday on Monday so I intend to spend today shopping and cooking, hopefully that will help!

thanks everyone

phd - I was induced for my first VBAC - yes it increases the risks, but still only to s small number (albeit bigger than with no induction).

Thing is phdlife - you're only 40+6 at the moment, yes? That's not even officially postdates yet and anything can happen between now and Tuesday - chances are you'll have delivered by the time you're 42 weeks whether or not you're induced!

The procedure they're mentioning uses something called a Foley catheter which has a little balloon which is inserted into your cervix and gradually filled with water to manually dilate your cervix and stimulate prostaglandin induction. If you Google Foley catheter induction you should find some stuff, but iirc it's supposed to be quite effective, but can be quite uncomfortable.

It might be worth getting them to start doing regular (every 48 hours) membrane sweeps in the next few days as this can start things off a bit more quickly than waiting, particularly if you're being pressure to do something by 42 weeks.

Good luck phdlife. I didn't have any trouble arguing for a VBAC second time around, but unfortunately my waters broke and nothing happened for three days so I ended up being induced. I really really wished I'd just opted for another c-section, as the induction was awful and I had a c-section in any case. However that was a syntocin drip (which given that it was only 16mths since I had ds was probably unwise).

I hope your contractions get going, but otherwise I'd really consider going straight for another c-section.

I was induced early for ds and had a normal labour. Pethedine for pain relief, the midwifes told me my contractions felt strong but weren't doing anything and I would probably end up with a section.

They took me down to the labour room at 2, at 7 I woke up and no joke could feel his head. Dh told me I was barmy, I told him to lok lol but he didnt want to funnily enough! He called the midwife in who thought I was barmy until she bothered to look, yes his head was crowning. He was born at 7:11.

The induction wasn't a scary process for me as I knew he was better out than in iykwim as I had low waters. I will say one thing though that the contractions are a more acute pain because of all the drugs they have used to induce you. My dd was back to back and although it flippin hurt the contractions were no where near as sharply painful if that makes sense. Hope it all goes well.

Who's quoted you those ridiculous statistics regarding stillbirth going up so steeply when you go over?! Contact AIMS as soon as possible and get some up to date stats. I caved in with DD 4 years ago, when I got to nearly 3 weeks late and my latest research for DS (due in May) has confirmed what I thought back then... that is SUITS the medical profession to get you past the spectre of giving birth 'late'. Hold on if it's right for you.

phdlife If you are worrying about the arguing you think you will need to do once you get to hospital then try putting it all into a strong birth plan and make sure you have plenty of copies of it printed.

Look at this page for a really good example of a strongly argued VBAC birth plan.

hopefully it will alleviate some of the stress you are experiencing too.

I too am hoping for a successful VBAC in the next few weeks. Good luck.