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Old 07-11-2013, 08:54 PM   #1
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schedule c-section vs. induced VBAC

I didn't put this in either of the specific forums because I didn't know which one to put it in.

At the VERY beginning of my pregnancy I had a huge amount of anxiety (I guess that happens when you finally get pregnant after nearly 5 years trying!) My heart rate was up and I got nervous so I got a home blood pressure cuff and called the doctor. This was at like, 5 weeks preggo. They told me to check 3 times/day and to bring to log in with me. The first 3 readings I took were high 140/70 something. After that, since I had a plan, I felt better and my readings went down to around 115-120/65-75, consistently. The cuff was a little small too, which can actually read a higher reading than if the cuff is the proper size. I had had a few slightly high readings at sick appointments prior to this, like 130-135/80, but nothing consistent.

I took the log in, and off those 3 early readings she said I had chronic hypertension. I've had extra ultrasounds up to this point, though everything looks good and MFM doesn't want to see me for any more extra ultrasounds at this point and I've never had a high reading in the office, most have been like today 110/68. I am on no BP meds or anything. I did the 24 hour urine catch about 3 months ago and the total measuring for protein was 3.5, 3.5!! Like, NOTHING.

We were talking about my VBAC today while I signed my VBAC consent and I asked her how this would play out. She said by signing the consent I wasn't saying I couldn't change my mind, just that it was what I wanted. She said if for some reason I decide to do a csection or we need to do one (if he's breech) that would happen at 39 weeks. She said she'll let me go until 40 weeks and then at 40 weeks I have to decide if I want to go ahead with a planned csection (if things aren't favorable for induction, closed cervix, not thinned etc.) or be induced if things are looking good. Being induced raises the risk of uterine rupture to 1.8% according to my OB, but that is still quite comparable to major risks with a repeat c-section. Best case scenario I go into labor on my own prior to 40 weeks, but who the heck knows if that will happen.

Now that we've had this discussion I'm just not really sure what I want. I mean, I want a VBAC, but not an induction. I was induced with DD and that is what led to my c-section in the first place. She was not in an optimal position and pretty much got stuck, head turned, sunny-side up. She came out with a huge bruise on her little head from being pushed into my hip bones, instead of through my pelvis :-/

I just don't know what to do, does anyone have any advice?

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Old 07-11-2013, 09:07 PM   #2
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Re: schedule c-section vs. induced VBAC

I think I would look for a doctor willing to go 42 weeks. Many women don't go into labor until past the 40 week mark.
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Old 07-11-2013, 09:10 PM   #3
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Re: schedule c-section vs. induced VBAC

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I think I would look for a doctor willing to go 42 weeks. Many women don't go into labor until past the 40 week mark.
Not going to happen. I'm at the ONLY vbac friendly hospital within several hours of my home. VBACs are not encouraged here. If I didn't have the supposed "chronic hypertension" she would let me go past. Yes, I know I don't HAVE to do anything, but I don't want to lose the care of my OB, because otherwise I really like her and she's been great about everything.
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Old 07-11-2013, 09:52 PM   #4
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Re: schedule c-section vs. induced VBAC

Because it was only an episode and has not continued throughout your pregnancy, I'd ONLY consider induction if it became medically necessary. Otherwise, Id be going past 40 weeks and starting labor on my own. I would not tell the doctor of these plans, I'd just play it out until 40 weeks, and if my blood pressure was still fine, just refuse the csection and induction at that point. At 40 weeks, it is illegal for that doctor to drop you. She cannot refuse you care. If you told her of these plans ahead of time, I guess she could drop you. If she is your only option, that's honestly what I would be doing. I wouldn't let even a "nice" doctor bulldozer me into unnecessary interventions that could harm my baby.
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Old 07-11-2013, 09:58 PM   #5
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Re: schedule c-section vs. induced VBAC

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Because it was only an episode and has not continued throughout your pregnancy, I'd ONLY consider induction if it became medically necessary. Otherwise, Id be going past 40 weeks and starting labor on my own. I would not tell the doctor of these plans, I'd just play it out until 40 weeks, and if my blood pressure was still fine, just refuse the csection and induction at that point. At 40 weeks, it is illegal for that doctor to drop you. She cannot refuse you care. If you told her of these plans ahead of time, I guess she could drop you. If she is your only option, that's honestly what I would be doing. I wouldn't let even a "nice" doctor bulldozer me into unnecessary interventions that could harm my baby.
I didn't know they couldn't legally drop you at 40 weeks, interesting. I am definitely okay with that plan, so long as my BP stays good.
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Old 07-11-2013, 10:00 PM   #6
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Re: schedule c-section vs. induced VBAC

Ditto to what crunch!910 said. You can always schedule a induction or a c/s at 42 + weeks. I went 16 days over before caving to an induction which led to a failed v-bac due to no progression. They will put a tremendous amount of pressure on you to do both before, but you can delay it if you really want to. You can also go as long as you want and simply walk into the hospital in labor and get whoever is on call. If you are laboring fine they won't order a c/s until necessary.
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Old 07-11-2013, 10:06 PM   #7
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You can always "schedule" those things and then call in and keep pushing it out. Say you have a family emergency, can't find childcare, etc. :-)
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Old 07-11-2013, 10:12 PM   #8
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Re: schedule c-section vs. induced VBAC

Just be aware some doctors will send the police to check on you and attempt to escort you to the hospital. This happened to a woman I knew. She refused the escort and eventually had a vbac. I translated for her so got to hear the story.
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Old 07-11-2013, 10:23 PM   #9
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Re: schedule c-section vs. induced VBAC

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Originally Posted by qsefthuko View Post
Just be aware some doctors will send the police to check on you and attempt to escort you to the hospital. This happened to a woman I knew. She refused the escort and eventually had a vbac. I translated for her so got to hear the story.
Wow. That's crazy.

To the OP, I agree with the others that you should avoid the induction. If they're pressuring you big time, ask for a mechanical induction without the use of pitocin. From what I understand, it's the pitocin that causes the increased risk of rupture. Remember, though, that you're paying the doctor. They are your partner in the process, but ultimately you are the one who has to live with your decisions, so they should be your decisions, not someone else's for you.
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Old 07-11-2013, 10:57 PM   #10
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I didn't think most doctors would induce for a VBAC due to the risk of uterine rupture? My understanding is that the risk of rupture with a VBAC is around 2% but that it goes up drastically when Cytotec is involved and that only a minimal amount of Pitocin can be safely used. I guess it depends on what kind of induction your doctors talking about but I would choose the c-section over induction following any kind of uterine surgery, personally.
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