Help! Possibility of early induction, can I still VBAC?

littlemac1117 · October 2012

So, I am getting way ahead of myself, I know. I am going to do some blood work on Monday because my midwife has some concern that I might have cholestasis. Everything that I have read about it says that the usual procedure is to induce around 37-38 weeks.

I recently had a really good talk with my mw about what would happen if I needed to be induced for going post-dates. Basically she told me that as long as me and baby are doing alright and that my cervix has started to do a little work on its own, she wouldn't think of inducing me until closer to 42w.

The thing I'm worried about is what if I have to go with the early induction for cholestasis? I am so terrified that if my body isn't ready when they want to induce that it is just going to fail and I'll end up with a RCS after laboring for however long on pit. Has anyone had to be induced early (for pre-e, cholestasis, gd, etc) and been able to have a successful VBAC? I am really worried that this may take my VBAC off the table.

I know I haven't even done the blood work yet and that I am way ahead of myself, but I just like to sorta mentally prepare myself for all situations. Thanks in advance for any info

cchill01 · October 2012

I was not early, but I was a very tight 1cm when they started the pit for my induction. I had been the same 1cm for at least 3 weeks. So, theoretically, if I had gone in early for my induction, it might have worked too.

They usually want you to be a little more open, but my MW was willing to give me a shot. She gave me a little chat about how my odds were just okay, but it was definitely worth a shot. 9 hours later, DD was born vaginally. Talk to your MW and find out what her policies are for induction.

littlemac1117 · October 2012

Molly&:
I would also find out how necessary the early induction is for cholestasis. I honestly have no idea, but I am curious because with DD I had gallstones and eventually cholecystitis so I had my gallbladder removed shortly after she was born (and she was 11 days late). However, I wasn't diagnosed until after I already had given birth and I'm not sure how cholelithiasis (gallstones) differ from cholestasis.
Basically I don't know much about it at all so I don't really have grounds to say this, but if I were you I'd make sure the medical induction is certainly indicated before going through with it.

Everything I have found has said that cholestasis increases the risk of stillbirth, especially after 37/38 weeks. I think it is one of those things that can go from okay to really not okay very quickly, so they want to be on the safe side. Just from me telling her about my itching (that is the most common and sometimes the only noticeable symptom) she told me that I need to be really vigilant doing kick counts, and that if I notice any decrease in movement (during normally active times) that she wants me to just come into L&D.

littlemac1117 · October 2012

Thanks ladies! Obviously, I will do whatever I have to for my baby to be safe, but I was scared that this would take my vbac off the table. Hopefully my mw continues to be as pro-vbac as she has been so far. My last conversation with her went really well and she seemed really open to giving me time and trying a lot of things before going to a rcs. Thanks!

Angela814 · October 2012

I'm confused. You already had a c-section? I was told that it's dangerous to induce for a VBAC. The chance of uterine rupture increases with induction (both before and after a c-section), and with a c-section, the uterus is already weakened by the scar tissue.

preg_amy · October 2012

I would still give it a shot if your MW gives the go-ahead. Cholestasis is nasty, and I wouldn't mess with it, so I would just follow your doc's advice on induction there.

I know some practices won't let you induce with Pit, I know mine wouldn't. They did give me some pit to augment labor. I would look at foley bulb induction if you still want to try the VBAC.

Remember that you have choices. If you do start an induction and change your mind, the plan can be changed to be a c/s if that's what you feel more comfortable with.

littlemac1117 · October 2012

preg_amy:
I would still give it a shot if your MW gives the go-ahead. Cholestasis is nasty, and I wouldn't mess with it, so I would just follow your doc's advice on induction there.
I know some practices won't let you induce with Pit, I know mine wouldn't. They did give me some pit to augment labor. I would look at foley bulb induction if you still want to try the VBAC.
Remember that you have choices. If you do start an induction and change your mind, the plan can be changed to be a c/s if that's what you feel more comfortable with.

Thank you. I am going in tomorrow for testing and I may see if I can get them to check me to see if I am softening at all. My mw was comfortable with using a low dose of pit only if my cervix has made some changes, but that was what she said when we were talking about what they would do if I went post-dates. I don't know how they would feel about an induction at 37 weeks. At this point, from the things I have heard/read about induced vbacs, I am still more comfortable with being induced than I am with a rcs, especially because I would like to have more kids in the future. Obviously I trust my mw. I will probably update and maybe have some more questions tomorrow after I speak with her, thank you all again for the great information and support!

cchill01 · October 2012

Angela814:
I'm confused. You already had a c-section? I was told that it's dangerous to induce for a VBAC. The chance of uterine rupture increases with induction (both before and after a c-section), and with a c-section, the uterus is already weakened by the scar tissue.

Induction with cervical ripening medications (cervadil, cytotec) is more risky and not used for VBACs. But, other induction methods (pitocin, AROM, foley bulb) are usually considered safe. Many of us here had pitocin inductions for our VBACs.

MAprincess · October 2012

I was induced for my VACat 41 weeks. MAYBE a fingertip dilated and I delivered vaginally just fine.

littlemac1117 · October 2012

cchill01:
Angela814:
I'm confused. You already had a c-section? I was told that it's dangerous to induce for a VBAC. The chance of uterine rupture increases with induction (both before and after a c-section), and with a c-section, the uterus is already weakened by the scar tissue.

Induction with cervical ripening medications (cervadil, cytotec) is more risky and not used for VBACs. But, other induction methods (pitocin, AROM, foley bulb) are usually considered safe. Many of us here had pitocin inductions for our VBACs.

This is good to know. Also, angela814, I don't really know why you could be confused. I mentioned vbac in my OP and I am posting this on the vbac board...why would I do that if I hadn't already had a csection?

palma44 · October 2012

I don't see any reason you wouldn't be able to try VBAC still, I was induced early at 34 weeks and they still put me on pit and let me try vaginal, I don't think the induction should have anything to do with it. I have heard pit can cause fetal distress which quickly leads to c-sections.

Good luck!

Angela814 · October 2012

littlemac1117:
cchill01:
Angela814:
I'm confused. You already had a c-section? I was told that it's dangerous to induce for a VBAC. The chance of uterine rupture increases with induction (both before and after a c-section), and with a c-section, the uterus is already weakened by the scar tissue.

Induction with cervical ripening medications (cervadil, cytotec) is more risky and not used for VBACs. But, other induction methods (pitocin, AROM, foley bulb) are usually considered safe. Many of us here had pitocin inductions for our VBACs.

This is good to know. Also, angela814, I don't really know why you could be confused. I mentioned vbac in my OP and I am posting this on the vbac board...why would I do that if I hadn't already had a csection?

I was confused because my OB was so adment about the dangers of any kind of induction with a VBAC. I honestly didn't know that any doctors were okay with inducing. Mine made it seem like it just wasn't done ever.

MAprincess · October 2012

Angela814:
littlemac1117:
cchill01:

Angela814:
I'm confused. You already had a c-section? I was told that it's dangerous to induce for a VBAC. The chance of uterine rupture increases with induction (both before and after a c-section), and with a c-section, the uterus is already weakened by the scar tissue.

Induction with cervical ripening medications (cervadil, cytotec) is more risky and not used for VBACs. But, other induction methods (pitocin, AROM, foley bulb) are usually considered safe. Many of us here had pitocin inductions for our VBACs.

This is good to know. Also, angela814, I don't really know why you could be confused. I mentioned vbac in my OP and I am posting this on the vbac board...why would I do that if I hadn't already had a csection?

I was confused because my OB was so adment about the dangers of any kind of induction with a VBAC. I honestly didn't know that any doctors were okay with inducing. Mine made it seem like it just wasn't done ever.

Your doctor is incorrect. It is done often and there is ample research to support it's safety in VBACs. It still carries the regular risks as a non-VBACer would have. And this is only pit, no cervadil (that is NOT recommended).

But many doctors claim that it is dangerous either because they are not informed or they just want to get to the c/s.

littlemac1117 · October 2012

Did my blood work today (it'll take a few days to get back), and got to talk to my mw about induction. Basically she told me that we would take everything slowly, and that it would probably be closer to 38/39wks, which was great to hear. We are waiting to talk further until we get my test results back, because the necessity of the induction has a lot to do with how elevated my bile salt levels are (the more elevated, the more urgent, I think). I am really relieved to hear that so many successful vbacs have happened as the result of induction. Thank you all so much for your advice/input/information! I really really appreciate it

penguingrrl · October 2012

I was induced for pre-e with my VBAC and it was successful. My OB kept me on bedrest as my BP crept up and held off as long as she safely could to give my body time, but in the end I needed an induction.

Cervadil is contraindicated in a VBAC, so you will need to have had some progress on your own, but pitocin is safe for a VBAC, so as long as you don't need cervadil you may be able to. Good luck!

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