If you’re reading this, you are likely looking for some answers regarding VBAC induction. Many have been in your shoes.
Many obstetricians and gynecologists may suggest that you have an Elective Repeat Cesarean (a repeat c-section is setting a surgery date at 38 weeks, so that you are less likely to rupture), natural birth, or a vaginal birth.
What’s your reason for a VBAC Induction?
Are you past your due date and feeling like the last month is 100 days long?
Whatever the reason, a current US Survey [1] has shown that 9 out of 10 women who have had a emergency c-section have had their doctor strongly suggest they repeat a Cesarean Section instead of trying to VBAC, even though VBAC carries less risks to mother and baby, and future pregnancies.
And yet, VBAC Bans and pressure from Doctors’ Liability insurance have put undue pressure on mothers looking for alternatives to the elective cesarean.
The current ACOG Ethics Committee has strongly stated that doctors should not be using coercion tactics [2] when their patients refuse their recommendations.
How is it that 9 of 10 are being encouraged to repeat birth by cesarean and it not be coercion?
Getting past that point, now what about induction for a mother who wants to VBAC?
VBACFacts [3] states that spontaneous labor is preferred over induced labor.
It goes on to say that when deemed medically necessary, a well thought out induction can be the difference between a VBAC and an Elective Repeat Cesarean.
So, wait…
Induction is a leading factor in the higher rate of Cesareans in the first place and now it’s something to consider for a successful VBAC.
Is your head spinning yet?
It is a leading cause of primary Cesareans, and yet it’s offered as a possibility to avoid an Elective Repeat Cesarean.
Information about the risks of induction is not as common as induction itself.
A survey done in Germany asked postpartum mothers about their perception of induction and why it was performed for their births.
(Schwarz, Gross, et al., 2016) [4]
Over half the reasons why induction was performed were for:
- post dates, 51.7%;
- next was doctor’s recommendation, 31.6%;
- and medical complications, 25.6%.
The total for these three top answers is 108.9%, which suggests that more than one answer was permitted.
Over half of the women who volunteered for this online survey had wanted more information about the benefits and risks of choosing induction.
Within days of the survey going online, more than half of the 600+ women surveyed wanted more time for labor and more support… They wanted to know alternatives, and give more input with their decision making.
It’s pretty clear that induction needs to be talked about prior to being in labor so that mothers can make an informed, thoughtful decision on what risks they would like to take or avoid.
This especially goes for a mother seeking a VBAC with a possibility of induction.
What Are The Risks?
Risks for induction are pretty serious for everyone.
Inducing could lead to premature birth or umbilical cord issues while delivering, and also to an emergency Cesarean.
Medications used in induction like oxytocin and prostaglandin can affect the baby’s heart rate.
Sweeping the membranes, breaking water or using a catheter can introduce infection to both baby and mother.
Let’s face it, hospitals are not clean of germs.
But wait, there’s more!
Inducing risks don’t stop with delivery.
When inducing, it makes the body do something it hasn’t been ready for.
If labor didn’t begin, it could also mean the body would have issues with knowing what to do after delivery.
If your body’s hormones haven’t started playing a part in the labor, then it may struggle with contracting after giving birth.
That could lead to heavy bleeding after birth, and more obstetrical management, which can mean less bonding time with baby after the birth, and difficulty nursing.
Birthing hormones regulate birth and nursing and postpartum emotions.
If you don’t get them in labor, it can change the entire birthing experience.
When your body goes into labor spontaneously, natural oxytocin crosses the blood-brain barrier.
It is the bonding hormone.
The synthetic version Pitocin does not cross the blood-brain barrier, it only prepares the body.
This could delay the bonding that happens with naturally occurring hormones.
Sara Wickham, Australian midwife and author of Inducing Labour: making informed decisions [5] wrote an article called “10 Things I wish Women Knew about inductions” [6] It’s great material that approaches induction from a different perspective. Read and bookmark it before you need it.
Let’s get a big question out of the way.
What About Uterine Rupture?
The biggest risk for uterine rupture is neither a trial of labor nor induction.
The biggest risk is one you can’t change; it’s having had a prior Cesarean Section.
The possibility of rupturing during labor with a uterine scar is still less than 1%, and this even varies depending on the type. A Low transverse scar has a one in 5,000 chance of rupture. [7]
It’s worth sharing that spontaneous labor also does not guarantee protection from a uterine rupture.
Speaking of Spontaneous Labor - Check out Lisa Malambri Labor Stages!
The underlying question is one about safety.
You want the best outcome for birth and all the stats that go into birth are averages.
It doesn’t matter that the average is less than 1% to the one in 519 that it actually happens to.
The risk is a relative term.
You have to pick what risks you are willing to take on.
What is the risk for one may not be for another.
A personal note from Kerry Olvera:
The one time I was induced, it did lead to a Cesarean.
After that, I decided I did not want that type of medical care and went on to have three larger babies.
I opted out of a system that put time limits on a mother with a scar.
I chose a midwifery practice that didn’t see me as a walking rupture waiting to happen.
Overall, induction does not significantly add to the risk factor for a VBACing mother, but it is a factor in Cesareans overall.
Be informed about VBAC induction, read the links provided, and take into consideration all the parts that make up your story. International Cesarean Awareness Network (ICAN) [8] is a support group made of volunteers and other moms that birthed by Cesarean that will help you decide how to approach your labor and team.
Resources:
- http://transform.childbirthconnection.org/reports/listeningtomothers/
- http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Ethics/Refusal-of-Medically-Recommended-Treatment-During-Pregnancy
- http://vbacfacts.com/2012/05/27/myth-vbacs-should-never-be-induced/
- http://www.ncbi.nlm.nih.gov/pubmed/27060393
- http://www.amazon.co.uk/Inducing-Labour-Making-Informed-Decisions-ebook/dp/B00KHEMLHO
- http://www.sarawickham.com/wp-content/uploads/2014/10/AIMS-Ten-things.pdf
- http://www.vbac.com/what-is-a-uterine-rupture-and-how-often-does-it-occur/
- http://www.ican-online.org/
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