19 thoughts on “Myth: VBACs should never be induced

  1. Andrea Gagen

    Thanks for the article. My 2nd VBAC was augmented using a foley bulb and pitocin. I was overdue and had Gestational Diabetes, but was thankful that my doctor and the hospital gave me that option.

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  2. Raeann Peck

    Under the heading “Medical Reasons for Induction” I was surprised to find placental abruption. Those are typically resolved only by C-Section rather than induction. Abruption typically causes severe fetal distress and/or fetal death, not to mention internal maternal hemmorhage. It’s an emergency C-Section situation.

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  3. Details

    I’m not so sure I trust that Mayo Clinic quote since it put abruption in the VBAC catagory when as Raeann point out it should be a c-section, and they put Low aminiotic fluid and slower growth in the time to do something catagory when it really should be time to watch and wait. And then the fact that pre-eclampsia was not specifically mentioned and high blood pressure and diabetis are lumped into the last bullet which should have been near the top. I would expect them to put the most dangerous thing first and the least studied last. Barring that I would expect the most often first. I don’t think they did either. Someone really should come up with a list of reasons to induce before 40 weeks and reasons to induce after 40 weeks, after 41 or after 42.

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  4. Stephanie Fuhrmann

    Where can I find the original information that led to this statement:
    Thankfully, a low-dose Pitocin and/or foley catheter induction “remains an option” in women planning a VBAC according to ACOG.

    I would very much like to have this as a last-resort option as I am overdue, but my OB does not want to use petocin to induce at all, even in small doses with a foley catheter (leaving me with no options other than spontaneous labor or scheduled c-section). I would very much like to find where this procedure and risks are mentioned by the ACOG so that I can try to start a discussion of using this option with my OB. Thank you!!

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    1. Jen Kamel Post author

      Stephanie,

      On page 454 under the heading “Induction and Augmentation of Labor,” ACOG states, “Induction of labor for maternal or fetal indication remains an option for women undergoing TOLAC” and then goes on to discuss several studies which illustrate that Pitocin has lower rupture rates than prostaglandins. ACOG also states that Cytotec is contraindicated in VBACs here, “Evidence from small studies show that the use of misoprostol [Cytotec] in women who have had cesarean deliveries is associated with an increased risk of uterine rupture. Therefore, misoprostol should not be used for third trimester cervical ripening or labor induction in patients who have had a cesarean delivery or major uterine surgery.”

      Some OBs don’t like to induce, others are ok with it. ACOG says it “remains an option.” Unfortunately, when OBs do not wish to induce, moms are left with no choice. It’s doubtful that showing her ACOG’s guidelines will make an impact on her, but it’s always worth a try.

      You can chat with VBAC supportive OBs over on the VBAC Facts Community.

      Warmly,

      Jen

      Reply
    2. Theresa Tarsa

      I would love to know what Stephanie ended up doing. I am in the same exact situation and tomorrow I will be 6 days late and have an appt. for an internal. im not sure where it will go from there but I do know that I will be getting a non stress test on the baby and an u/s (probably the next day) My Dr keeps saying there was no point in checking me bc they cant induce and I need to go naturally, but now shes saying I really shouldnt wait past 41 weeks (according to them is Tues (2days away) according to me who knows my exact conception was 2 days ago. Anyways she says that ultimately I am the boss but she keeps bringing up a c-section even tho I have expressed how much I dont want one especially having a 21 month old to care for too. I will be bringing up the low dose pitocin approach. I have also read somewhere ese that some Dr’s are more comfortable with that if you have started dilating to help kick start labor. So we shall see.

      Reply
      1. Jen Kamel Post author

        Hi Theresa!

        Hopefully Stephanie will see your comment and respond. I’m so sorry you are in this situation. It’s certainly not ideal.

        I posted your question here to get more feedback.

        Best,

        Jen

        Reply
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  6. Geneva

    I have a question. I am 37 weeks with a breech baby (has been breech since 32 weeks). Yesterday I had an external version by a maternal fetal medicine MD. I scheduled this myself as my office doesn’t do them. The baby turned, but then turned back breech shortly after I left the hospital. The MD had said if they had to try the version again, that they could induce labor immediately afterwards. My first thought was that this would be difficult for me. My office that I have been seeing for my whole pregnancy just wants to do a scheduled c-section on December 10th. My due date is December 14th. It seems as if I switch my care to the provider that did the version, I may have more options. I honestly don’t know what to do though. Is is safe to be induced after a version for a baby that has been persistently breech? Should I just stick with the plan and get the c-section at 39 weeks? Should I just wait and see what happens? I mean baby could turn by himself and I could go into spontaneous labor. Of course this is what I want, but what if it hasn’t happened yet by December 9th. I really don’t want the section.

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  7. Geneva

    sorry, this will be a VBAC attempt for me. I have had one vaginal birth after induction (2005) and one spontaneous labor that ended in a c-section due to my inability to push out a posterior baby (2008).

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  13. Gabor Sz.

    Our first born was an emergency C-sect 21 months before, due to pre-eclampsia on g. week #34. My wife (35) preferred a VBAC for baby #2 (also a girl) due 01/2016.
    The 2nd birth was a successful VBAC but there were lessons learned:
    -we should have studied which hospital/doctor would enable the VBAC the most flexible way – not at any cost, but to a reasonable extent. We were lucky to have the best doctor around on his schedule that time. We could have arranged a doctor if we wished to do so but only before g.week #20.
    -last 3 hours of labor was induced using oxytocin which was said to be not allowed on previous visits but the doctor conducting birth did let it
    -infusion and constant baby hr monitoring was used all time, no foods/drinks allowed.
    -after delivery,a touch-in check of the scar (previously measured by ultra sound as 5mm thick) – was performed in a short narcosis,so breastfeeding was almost instantly allowed afterwards.S car was found intact.
    Venue: Hungary,outside of Budapest

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