Isabel recently asked over on Uterine rupture rates after 40 weeks:
“I wonder however if there are studies that compare the method of induction. My Doula said that the increase rates of uterine/ scar rupture was due to using high dosages of Pitocin, but now the induction uses lower dosages and administered at longer intervals. Do you know something about this? Thank you”
A few factors to consider:
1. Induction protocols can vary by provider, including some providers who don’t induced planned VBACs at all. 2. Induction guidelines can vary by hospital. […]
Many moms and midwives use evening primrose oil (EPO) for cervical ripening. So I was absolutely shocked at the complete lack of evidence on the effectiveness and safety of EPO among pregnant women. There is one study that examined the oral use EPO during pregnancy. It concluded EPO didn’t work as we expected it to and further, women who took EPO were more likely to experience a whole host of complications. Shockingly, there are no studies on the vaginal use of EPO during pregnancy. In short, there is insufficient clinical evidence documenting the risks and benefits of EPO and without that information, should pregnant women take it? […]
Spontaneous labor is always preferable to induced or augmented labor but there are medical conditions that can necessitate the immediate birth of a baby. It’s nice for those women for whom vaginal birth is still an option to have a choice: gentle induction/ augmentation or repeat cesarean. Of course, informed consent reviewing the risks and benefits of their options is essential. Some women might be more comfortable scheduling a cesarean whereas others might want to give a gentle Pitocin and/or Foley catheter induction a go. […]
Update 1/20/12 – Someone who believed this birth myth to be true, told me that the source of this information was an OB from St. Louis who presented at the 2011 ICAN conference. I contacted ICAN and they said that the person must be referring to Dr. George Macones. Yet, no one on the ICAN Board, who were seated at the front table during his presentation, remembers him saying that induced, unscarred women have the same risk of uterine rupture as a VBAC mom. And I would think that if he gave a stat like, everyone would have remembered because […]
There is this idea that if you don’t VBAC and you schedule a repeat cesarean, that you will be safe from complications. This is because during a “VBAC counsel,” women are often told of the risks of VBAC, namely uterine rupture, but they are rarely told the risks of repeat cesareans in their current and future pregnancies.
Abnormal placental implantation is one risk of cesareans that only present themselves when you get pregnant again.
Women who expect to only have two children, and thus opt for a repeat cesarean, might think that not VBACing is the safer, and more controlled […]
This article published June 19, 2009 demonstrates one hospital’s experience when they changed their oxytocin (Pitocin) protocol.
I’ve included the entire article below and have emphasized what I consider to be the most interesting parts.
Hospital’s Oxytocin Protocol Change Sharply Reduces Emergency C-Section Deliveries By Betsy Bates Elsevier Global Medical News Conferences in Depth
CHICAGO (EGMN) – The modification of the oxytocin infusion protocol at a large university-affiliated community hospital nearly halved the number of emergency cesarean deliveries over a 3-year period, reported Dr. Gary Ventolini.
As oxytocin utilization declined from 93.3% to 78.9%, emergency cesarean deliveries decreased from 10.9% […]
This is a question that I’ve heard a lot.
Here is the three second answer: VBACs got a bad rap in the 1990s before we understood the increased risk of rupture during an induced VBAC labor, especially with Cytotec. Even if your OB is supportive, s/he may be under pressure from hospital administrators, or other OBs in their practice, who feel differently. Finally, your OB might have experienced a recent lawsuit, uterine rupture, or other bad outcome that influences the way they counsel you.
In the 90s, babies and moms were unnecessarily injured and died when VBAC labors were induced […]
I recently received this comment.
Hi…thank you so much for your site! Very informative. I live in Glendale and I had a c-section last year with my first daughter. I went in to be induced even though I wasn’t looking forward to it. No contractions. No mucus plug. No water broken. I guess I just wasn’t ready for labor yet. They hooked me up to an epidural because they said I was going to feel immense pain so I went with it. 26 hours went by and I never dilated so they gave me a c-section at citrus valley medical […]
This is a great piece for deciding between VBAC and repeat cesarean. Those who wish to VBAC, but have husbands, family, and/or friends who don’t understand why, might find this document very useful. I have found that people who are anti-VBAC really seem impressed by what doctors and medical organizations have to say, so I’m thinking they will find this document compelling. Plus, VBAC has this reputation of being “risky” and repeat cesareans are thought of as the “conservative approach,” and this document challenges both lines of thinking. Why not write a sweet little note like, “I know you are […]
This post on a pregnancy message board under the subject “Inducing at 38 weeks” was the catalyst of a discussion on the ICAN email list (emphasis mine):
I’m for it! There is NOTHING wrong with me, actually not even THAT uncomfortable (knock on wood!), and my Dr. is inducing me at 38 1/2 weeks! The group induces all of their patients! He said by 38 weeks the baby is ready – so why not get them out in the real world! I know it’s REALLY because they are 3 men, who just don’t want to get called out in the […]