Can we talk induction, the drungs and intervention (VBAC related)

[moonstorm]

I've been trying to find more about my VBAC and keep coming across the fact that intervention should be avoided. Also things like epidurals can be bad news for vbacs. What drugs should be avoided for inducing and why? Does a sweep really work? (It's seems only to work if something would have happened anyway...). Can anyone help? I'm getting confused!!!

Hi there. I have had a VBAC, but I wasn't induced, so the info I know is from research I done when pregnant.

Drug induction isn't used very often as induction can cause a much more intense labour which then puts extra strain on the scars from your previous section, which in turn raises the risk of uterine rupture.

Some hospitals won't induce a VBAC and some will. I guess each hospital and each Ob's have a different approach.

One of the risks of vbac is uterine rupture and one of the warning signs of uterine rupture is scar pain. So, if you have an epidural you will not feel scar pain if there is any.

Sweeps only work when your bosy is ready to go into labour, so are a bit of a moot point. However current research shows that 3 sweeps on consecutive days are the most effective.

Most hospitals use a horrible phrase for VBAC'ers which is 'trial of labour'. In a (crude) nutshell this means your labour has to fall inside strict guidelines, ie your cervix must dilate one cm per hour etc. In their eyes everying has to go to plan and must be done in a certain amount of time. Epidurals can slow labour down, which isn't really want you want when you have to labour against the clock.

This all sounds really negative, but please don't think it has to be that way.

Most hospitals won't induce a VBAC.
Some doctors will give you a little tickle of synto to hurry things along once you're in labour but that is about it.

There are pros and cons of epidural. A positive is that if you needed a speedy emcs you could get one (unlike me- I ended up with GA!). But with an epi in you would usually be on your back with monitors on which would not be conducive to a natural, active labour. Active labour being likely to result in the best outcome.

I really recommend getting your hands on a copy of the VBAC Handbook by Savage and Churchill which sets out how to give yourself the best chance of a successful VBAC. Not every attempt is highly medicalised. I laboured at home, arrived at hospital 10cm, went to the birth centre and got into the pool. The shit then hit the fan and I transferred for emcs, but if the baby's heartbeat had been better I like to think I might have had a pretty natural birth. And without all those drugs/internals and other fuss the pain was surprisingly manageable.

Good luck. I hope you get the birth you want.

Hi - I had a (sort of) induced VBAC. Waters went and 34 hours later, although I'd had several hours of contractions, labour was not established, so I was put on a very low level of syntocinon. Also had an epidural (although as soon as it was in, I moved, baby shot down and was born 15 mins later!)

MW at the time said that it was 50/50 as to the con obs that would suggest induction but as I was looking favourable (body had started to labour, just hadn't kicked in fully, DD in prime position, v small cs scar (on the outside at least!!)) it was a good option.

I was very closely monitored, had CFM (although kept moving around, no pressure to remain on the bed) and DD arrived less than 7 hours after the drip started. It was very positive and I'm very grateful that I was given the chance to labour - rather than simply taken in for a section as I'd expected.

Have you spoken to your consultant or midwife about the options? Mind you, when I discussed it whilst PG, I was told that induction was not an option (for the reasons ILikeToMoveItMoveIt outlined!)

Aaah Haliborange, sounds like I had the 'tickle of synto' (hmm, didn't make me laugh tho!)

Halibo - I read gas and air instead of general anaesthetic!!! Was stunned for a second!

Ilike to

"Most hospitals use a horrible phrase for VBAC'ers which is 'trial of labour'. In a (crude) nutshell this means your labour has to fall inside strict guidelines, ie your cervix must dilate one cm per hour etc. In their eyes everying has to go to plan and must be done in a certain amount of time."

That worries me slightly - I have never experienced labour (waters went without warning, prem ds, breech, GBS and 'urgent' cs) - so I think I'll be like a first timer. Worried that due to GBS, I'll have to get to hospital asap, whereas other advise is to delay going into hopital for as long as possible...

I am going to write a list of questions for consultant...

Moonstorm - I'd had an ELCS first time round so was a complete first timer....and I had to hang around the hospital for hours (waters going etc). You can still do it!

Yes, list of questions a good idea...the registrars loved it when I got my notebook out!

Read up on GBS if I were you. From my knowledge of it it comes and goes. So at say 30 weeks you may test positive, but at time of delivery you may test negative and vice versa.

Defo make a list and talk to your consultant about everything that is on your mind.

Go through all of your points and come up with a solution that is mutually agreeable. It can be done, you just have to be firm and stand up for yourself sometimes. It would be a good idea to take your partner with you for moral support.

Good luck

Llike

I'm going to get tested at c.32 weeks to cover me for prem labour again, then again at 35/36 weeks to cover me for normal gestation so I'll know either way. If negative I'll be really happy, but if positive... (cs doesn't make risks lower, so I'll still want to do for vbac, it's all the intervention stuff again...)

Thanks

Ask the consultant as much as you can. Consultant booked me in to be induced on my due date as 'there is compelling research showing that there are greater risks to the baby if you go over your due date'. This totally went against what the midwives had told me - that it should be slow and natural and I was so gobsmacked that I agreed and went ahead with it without really challenging him at all.

They progressed things very slowly as sweeps before my due date hadn't worked. A small amount of syntocin and then 12 hrs later broke my waters with dd finally being born about 9 hrs after that. It was slow and medicalised but I managed to avoid another CS so was really pleased. I didn't have an epidural.

Don't know if all that's useful to you, but my advice is ask as many questions as you can before you make your mind up.
good luck

Hi Moonstorm, I think we're at the same hospital aren't we? Or am I getting my MNetters muddled!

Anyway, if so our hospital does trial of labour. The midwife told me that you have to be progressing at a pretty remarkable rate ie 1cm an hour if not more and if things start to slow down for whatever reason they "pull the plug" That sounds very uncaring but I think they were telling me this as reassurance that I wouldn't be left for hours on end with nothing happening and me panicking. They also said that they wont use pessaries or other forms of induction, they would give epidurals but like others said it can slow things down and then you're cascade of intervention starts.

I did labour and push for two hours and I can honestly say it was totally managable and dare I say slightly enjoyable?? In a productive "look what Im doing" kind of way but my fear just comes from all hell breaking lose at the end?

I've bought and read the VBAC handbook and yes its a great book with some fab facts in it, but in my personnel opinion its made me slightly more wary!! And I think the only reason for this is because the case studies in it are a little bit scary! Well realistic should I say? they ARE reassuring that it is totally possible (one woman has a VBAC after 4 sections!) but it just felt a bit "out of the frying pan into the fire" for me with talk of forceps and ventouse.

Maybe Im just a big girls blouse or maybe Im looking for a valid reason to have a ELCS??

Anyway, Im now ploughing through Ina Mays guide to childbirth as more prep! Im happy to send you the VBAC guide if you like? it may really help you?

HTH
K