Induction methods for VBAC

[Unsure4589]

Hello! Those who have had/are planning a VBAC, could you share your experience of non-hormonal induction methods?

Due to my age (41), my consultant has suggested that we start with Dilipan-S rods, to be inserted around my due date (I intend to refuse before this point if all continues to be well).

I thought perhaps a sweep would be a good idea first and the consultant said I could, but then my midwife said the guidelines don't recommend it for VBAC candidates. Is this accurate? She wasn't sure why and tbh I'm not sure why a sweep would be contraindicated for a VBAC either. It's mechanical so I figured it'd be okay?

X-post in Childbirth. It's quiet over there!

Hi there. I'm only 17 weeks currently but I recently asked my consultant about this, as I know I'm not allowed certain induction methods after having an emergency c section with a complication where my scar is extended on each side, causing it to be weakened. He said a balloon induction could be attempted as this is more of a natural method compared to the hormone drips which should not be used. He warned that if the balloon did not work then it would be likely a c section would be required. Usually as part of fitting the balloon they sweep you, so I would expect a sweep to be permitted. Especially as when I previously had the balloon, it fell out on its own and the next day when they checked me they swept me again. On the way home my contractions then started. Hope all goes well for you! X

I'm 37w and going for VBAC all being well, was told by a midwife that lower dosed hormone drip is possible. And sweep at 39/40 weeks, if cervix is favourable.

I had heard of pessary and manual breaking of waters too. It's so confusing knowing which option to go with if induction is in radar.

Hi OP, I'm hopefully having a VBAC and have also been told hormonal induction would be avoided and they would use the rods. I wasn't told the same thing about sweeps though and have been advised to get one every few days from 39 weeks. I can't think why they would be an issue!

Thanks everyone! I’m not convinced my midwife has the right information about sweeps. Or it may have been one particular case she dealt with in which it wasn’t advised. I plan to ask again, and obtain a reason for not being able to have one as she couldn’t remember at the time.

@Zeeha, I know my trust prefers the rods to the balloon, so maybe ask about the pros and cons of both options when you get closer to the time!

@T2024, wow, I’d thought the pessary and gels were a no-go for VBAC! If they end up manually breaking my waters I know there’s a clock ticking before drip-time if nothing happens naturally. I’ll be having an epidural put in before I consent to that for sure. 😖

@Babyenroute, exactly the same bar the sweeps!

Good luck to you all!

P.S. I’m replying in the middle of the night due to the onset of yet another cold. So grumpy and not what’s needed at 36+1!

I can't remember the details because I ended up choosing a second section in exactly your age and possible VBAC situation, but my trust did have leaflet online detailing the options they preferred.

If in any doubt, IME, try birth reflections as they tend to be more knowledgable (sorry to say that, but my stream of midwives were so inexperienced they just couldn't answer any questions).

@Unsure4589 Yeah I thought all hormonal drip, pessary etc style inductions were a no-go too but I follow a VBAC group on FB and some of the group have had these. I think the risk of rupture is higher with hormonal drop with previous section, but my midwife said they don't put the dosage up as quickly with vbacs.

I'd love to go naturally and avoid induction 🙈 37+5 atm. Hope your cold clears up, always feels worse when pregnant! x

I got told by my consultant to have “as many sweeps as possible” from 38 weeks, and she also said I could have a balloon induction (but I intend to decline that).

She basically suggested that anything non-hormonal is fair game, and they only get antsy if it’s hormonal (eg pessary or drip), but as someone else has mentioned, once you start the path of induction with a balloon/rods, if it doesn’t work you don’t really have any other options, with a sweep that isn’t the case as you can have a sweep and if it doesn’t work, no harm done.

@retrievermum, thanks. That makes so much sense to me re. sweeps. Baby is tracking well from my last growth scan and I have another tomorrow, so we'll see.

I'd like to start getting 'swept' as soon as I'm done with work, which will be Wednesday 18th at 38+4.😂

No idea what my midwife is on about really!

I spoke to my midwife last week about a VBAC. She said I can have a sweep and balloon induction and a lower dose drip provided I was in labour to help things along.

It's a long time since I was in this position - both my VBAC babies are adults now - so things may have changed, but I was discouraged from induction, both because of the increased risk of a section resulting from a cascade of intervention and because of the risk of uterine hyperstimulation from hormonal methods.
However, I did go in for daily monitoring once I was overdue. I can't remember exactly when that started but definitely from 41 weeks onwards, and I had a couple of sweeps. With my elder son my waters broke at 40+9 but without regular contractions. I was offered either a section or having labour very cautiously augmented with syntocinon, low dose with very gradual increase and lots of monitoring. I chose the latter and all was well. My younger son was born without any intervention at 40+15. I may have had a sweep a day or two before actually, I can't remember for sure.
The only thing my Consultant was absolutely adamant about was no induction with prostacyclin pessaries, on the grounds, if I recall rightly, that unlike the drip you can't control things or switch it off if things start to look worrying. Otherwise he was very happy to discuss risks and benefits of different options with me and let me decide.

@MrsAvocet, they seem to be quite keen on induction these days in general 🙄I'm 41 though, so they really don't want to let me go too far past due date because of stillbirth risk. I'd have to be very firm with them if I wanted to go beyond 41 weeks, and I don't want to roll that dice particularly. But I have my fingers crossed for spontaneous labour and am doing what I can to 'prepare' for it.

Pessaries are a definite no at my trust, and yes a controlled hormone drip will be a final option if things don't progress post-waters going. I'm not going to be hooked up to one of those though without an epidural in place, in case I can't handle it. I have zero faith in an anaesthetist showing up in the nick of time at my hospital and even less interest in unnecessary suffering!