Induction after two Cesarean Births....

JerseyJess · 01-08-2007, 08:43 AM

Well this is a new one for me. My client's EDD is today. This is her 3rd pregnancy, last two were cesareans-one was a "failed" induction at 41.5wks(3 years ago) and the second she got to 9cm and +2 station cervix swelled to 8cm for 3hrs and she opted for a repeat(20 months ago). Her doctor was very open to another VBAC attempt with this pregnancy however now her fluid levels are borderline (5). She's going in today for an internal, if she's favorable she has the option of pitocin induction. He's told her that the risk of rupture does increase (to 2% ?) but says it's completley her choice. He is very laidback and is not pressuring her either way but does say that he feels strongly that baby be born by 41wks (and only that long if fluid stays steady at 5) Even at 41wks she has the option for induction-I've never had a VBAC mama offered induction before and I know she is leaning towards it....

Her doctor said that her scarring was minimal (he made this statement during her 2nd birth) and that he wouldn't have been so confident about another VBAC attempt if weren't.

I feel so out of my element here...any tips? Questions I should encourage her to ask? (She did ask and make sure that he doesn't use any kind of cervadil/ripening agent with VBACs, he does not)

tinamomof6 · 01-08-2007, 10:04 AM

mom that was attempting a VBAC with a midwives group. Her first c-section was an emergency for serious "fetal distress" Baby's heart rate was 40 and cord was very tight around his neck. For her VBAC attempt she ended up going 2 weeks past her due date and the midwives didn't feel comfortable letting her go any further...she was very small and the baby seemed very big. So, I was really curious how they'd procede with an induction. What they did was put a baloon catherter in her cervix then fill it with saline...this was to dilate the cervix. When the cervix gets to around 4 cm's the baloon cath will fall out. They put her on the lowest dose of pit. 2 and never increased it, then shut it off later in labor. Thankfully, her labor kicked in and she dilated to 10cm's with a totally unmedicated labor. Unfortunately, at the very last minute when she was fully dilated baby's heart rate dropped dangerously low and an emergency section was done...it was a placenta abruption. We were all devastated for her. She really is ok with it though. Disappointed, but happy that she labored naturally, that her baby got the benefits of his mom in labor, and that her baby was safe.

Tina

Jilian · 01-08-2007, 11:06 AM

I've always heard that it is a BAD idea to induce a VBAC. My own MW won't even suggest things like castor oil or sex/nip stimulation to induce a VBAC. It's a good idea to leave the uterus alone and let the baby come when he/she is ready. The mom isn't even "overdue" yet.

I can see how it would be frustrating for you. I find that the best thing to do it to educate clients BEFORE they have to make these decisions. It's harder to talkt hem out of something once they've already made up their mind 0 and it's not really your place to do so. I guess all you can do now is remind her of the risks and benefits of inducing a labor and support whatever decision she makes.

Kim Trower · 01-08-2007, 04:29 PM

I had a very successful augmentation with pit on a 3rd time mama (2 previous section births)...the main thing is these are all small numbers and stories. The mom has to do some soul searching on what she wants. It is nice that her doc is confident and supportive but how about upping those fluid levels and continuing on until labor begins on it's own. She does have the right to say no. IF she is comfortable with this doc and she wants to move forward then she should...give her all the info and support you can so she can move forward without fear and anxiety. Let her be in control and things should work out fine. good luck .