Please tell me about your VBAC inductions

[Pelvicflooragogo]

I'm attempting a VBAC after my DS was born 18mths ago after being posterior position needing syntocinon plus epidural and failed forceps despite being fully dilated. He was 8lb8oz.

I'm now due in 2 weeks with a very small girl which I think is fine as I was 6lb5oz but the obs doc is threatening an induction if she doesn't grow enough before 1st feb (next scan and appointment). Having gone through my birth plan with a specialist VBAC MW I'm now a bit thrown - what are my options?

I know I'm more likely to end up with an instrumental delivery or section if I'm induced and I can't labour at home at all - can I even labour in water? What happened for you ladies who were induced as a first attempt at VBAC? Any tips for me? Am quite anxious about it all, hopefully she'll put on a growth spurt and I'll pop on my own - am having acupuncture and 2 stretch and sweeps before the appointment.

Bump

Not sure if this is helpful or not but my hospital has a policy of not inducing VBAC's because of the increased risk of uterine rupture. Using a prostaglandin gel thins scar tissue as well as the cervix which isn't a good thing and synto drips tend to produce more violent contractions hence the increased rupture risk.

I know some places do still induce rather than recommend another section but I'd be very nervy.

Have you had a trawl through MN archives, google etc. ?

Inductions for VBACs are generally a big no-no as it increases the risk of uterine rupture greatly.

Personally I would not be induced for a vbac whatsoever. Use of prostins and synto are particularly high risk, occasionally some places will induce by inserting a catheter or breaking waters etc.

If you are not ready to labour naturally there would be a very strong chance of needing a EMCS for failed induction.

For me, if baby needs to come out, I would plump for a repeat section, however there can be some benefit to baby from experiencing labour.

I have had a vbac attempt and put in my birth plan I absolutely would not accept speeding up the labour with hormones for these reasons.

Cna I ask why the small size of the baby is promting an induction? I can understand it the other way round (is if the baby was big). Also, I know I've read plenty of posts on here about how drs get the predictions about the size of the baby wrong.

Anyway, apart from that, I was induced with DC1 and I would never ever go down that route again. As others have said, I don't think induction is recommended following a cs. I would ask for a second opinion if I was you.

I was induced with my DS, after a previous VBAC.

They started me off with the propess pessary, and although that did give me very mild contractions nothing came of it, so they gave me a second, and again that did nothing. The next day they broke my waters and told me to go for a walk for an hour to see if things would start on their own, but they didn't so they put me on the syncontin (sp?) drip to start contractions.

After about an hour the contractions started, and for the next hour or so they were managable through breathing alone. After that i had gas and air. They upped the drip several times, and then the contractions all seemed to merge into one big one, and i was in incredible pain, especially just where my csec scar was, so they lowered the drip and advised me that if i wanted to avoid another csection then i should consider an epidural. I agreed and tbh i'm so glad i did - i wasn't coping too well with the pain, and the epidural meant i was still able to have my vaginal birth, but without the pain.

Thanks for your story deemented. The 2 reasons they're considering induction were that the growth scan showed fractionally slowed growth rate and they saw basal calcification on the placenta which are a sign of it ageing and beginning to fail. The other foetal wellbeing signs were fine (good end-diastolic flow, fluid vloume, heartrate etc). So it's really only if the growth actually tails off so she's under the 10th centile line and if any of those other measures change that they would consider it.

I'm aware of the risks but am also aware that if my placenta is beginning to pack in (which happens earlier after a previous section) then I'm at risk of a stillbirth which is terrifying. I also have a very active toddler so the idea of going for an ElCS is not ideal. I also had a pretty traumatic time during my last one as I didn't have complete epidural block and felt pain during the op so am very very keen to avoid one.

If I was in your situation, I'd go for the elective cs. Having been through induction ending in an emergency cs which I was devastated about, I would still opt for a cs (and I have a toddler). My SIL had a (sort of) elective cs this year and she was up and about in no time at all. It took me 16 weeks before I felt anywhere near better after my emergency cs, so I don't make this suggestion lightly. Good luck with whatever you decide.

BTW, with induction, an epidural is very often needed (so I understand) as the contractions are being forced on yout body rather than being generated by your body.

I was induced with VBAC at 40wks + 10days. Actually went in for an EC but changed my mind at the last moment. They broke my waters, nothing, and then advised syntocin which I was vary of as I thought it was usually not advised. They said it would be a relatively mild dose so I tried. Also had epidural and about 6 hours later spent an hour trying to push which wasn't happening as baby was back to back. Had one last go with forceps and baby was finally delivered with venteuse just as they were about to do another EC.

I was induced at 40 weeks + 8 days. They told me they'd only break my waters, no gel or anything. They advised that I'd have 6 hours to show progress, then syntocinon would be offered and I'd be given a further 2 hours, after which it would be another emcs. As soon as they broke my waters I went straight into full-blown labour and gave birth less than 4 and a half hours later with only entonox for pain relief.

I'm feeling a bit freaked out by people's suggestions to go straight for a CS!

My hospital seems to be happy to do the whole usual induction process with VBACs. I am totally fine with having an epidural if I feel I need it or during an induction - am trying to keep an open mind. I think half of my problem last time was that I was convinced that the only good labour was one I had totally pre-ordered - water pool etc.

I am really okay with other forms of pain relief and I just need to get my head round potentially needing a CS again if needed. Does anyone know what induction/ CS rates are for VBACs? Might help me decide if they ask next Monday.

Will hopefully avoid it all as I think I had a show today! Grim!

Hi Pelvic, I was induced for DD3 at 40+1 following a VBAC for DD2, so not quite the same situation. Different hospitals have different ideas about inducing VBACs - my particular one (major maternity hospital, referral centre for the surrounding area) supports the use of synto but not pessaries. The reasoning is that once in, the drugs are in and cannot really be removed whereas synto is a short-acting drug so they can whip it out and your body will metabolise any remaining in your bloodstream fairly quickly.

They tried ARM for me first, but that did nothing - I had no signs of being in labour but DD3 needed to be out for medical reasons, so we had to get her shifting. I then had synto, and the put in an epidural first. This was my request - they were happy to let me start labouring with synto and then ask for an epi if I felt I needed it later. However, I had synto before and I am a wuss, so I opted for the epi. DD3 was born 4 hours later in what was by far the best birth experience of the three, no instruments, only 2 stitches in the scar tissue caused by the forceps delivery of DD2.

I did not labour in water but my hospital was not happy with anyone who was being induced labouring in water, so it was not connected to my VBAC.

Don't know if this helps and it's turned into rather a lengthy post

Well my MW says my cx is favourable and 2-3cm dilated so fingers crossed things'll happen before the scan on monday - have had 2 lots of show too (sorry if TMI!!!) so am feeling quite positive that either things will start on their own or induction would be fairly likely to work given how my examination went. Have another stretch and sweep (much less painful than first time thank God) booked tomorrow so am feeling really ready now...

Thanks everyone for your experiences.

Any update?

Yes! I'm so delighted to say that Ivy Tabitha Alice was born in water Friday 29th January 18.09pm weighing 6lb6oz after a natural labour, TENS and gas and air, out the next day. So very very chuffed!

The MWs were fabulous and so suportive, didn't feel like a high risk patient at all. I had the wireless CTG on and it wasn't at all intrusive. I also had a natural third stage so everything really was as natural as possible. Thanks for everyone's words of wisdom! Good luck to anyone in the VBAC waiting room!