Jules Michael Birth Story

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Comments

[Karen]

Good for you! Congratulations both on the birth of your son and for advocating for yourself. No one should have to advocate for their own health in a hospital, that's what the staff is supposed to do.

[Michele]

Congratulations on your VBAC!

That was AWESOME how you stuck to your guns, and wouldn't let anybody bully you. I applaud you for that! The sad thing is--you shouldn't even have to do that!! Those doctors actions,"I have been here all day, etc"...are sickening!!!! BTW, I am surprised (and a little annoyed) that no one from ICAN called you back! What chapters did you call?

It's really sad a woman has to fight like this in the hospital to birth the way she wants. You said over and over you were scared/upset etc....you shouldn't have to feel that way in labor. And the doc saying being stressed out isn't a cause for stalled labor? BULLSHIT!!!! What an asshole. Either he is stupid--or he KNOWS it's true and lied. Unbelievable behavior.

Gina, may I use your birth story on my website? It's called BirthCut (www.birthcut.com). Mothers (and Fathers) submit cesarean and VBAC birth stories, art, poetry, videos,etc. Just let me know! You can just email a copy to michele@birthcut.com if you'd like.

[Laura]

I am a lurker who has subscribed to your blog since you left the DDC on IV. I just wanted to say congratulations on the VBAC birth of your son. I am thrilled you were able to achieve what you wanted. You are a very strong woman and I admire that. Good luck!

[Kara]

I just came across this and wanted to say Congrats!!! Way to go standing up to yourself and getting your VBAC!

[Reiza]

Wow. I'm awed both by the incompetence of the hospital and by your strength and determination.

[ms. lis]

In a moment of vulnerability you had the reins and took control, no matter how bumpy the ride was.

Also, I was dubious about hiring a doula who was not a midwife as well, which is a common combination in my current neck of the woods. After reading everything that you posted about the subject matter at hand, I will say without even having to think about it very much that the doula was a VERY good choice and between her and your husband (and the arrival of many others including Kat.), your support team not only kicked ass but was even better, even stronger than what many "normal" folks get.

As quickly as possible, I want to discuss something that I noticed that you probably know already. You had a traumatic C-Section which you've been trying to deal with. The way you acted during labor as well as before birth (to a lesser extent) is probably a reaction not just to how you were being treated, but there seemed to be things that would trigger a certain reaction or thought from/within you.

Speaking from experience, I'd place some $$$ of saying that you have been suffering from Post-Traumatic Stress Syndrome. While I'm not a professional, I'm pretty certain. You should research this just a little bit as in PTSS can get very complicated, thus it can be difficule to explain. This research also might help to lead you in the direction of dealing and overcoming your previous C-Section.

Think triggers. I would guess that you have some "triggers" that cause a certain type of reaction out of you. By discovering these triggers, how they affect you/make you react, and what goes on inside your head, you can deal with your traumatic C-Section and possibly overcome it.

You have every right to have the feelings that you do concerning your previous C-Section, but it has (probably) in some ways taken over your life-- even if only a little bit. Overcoming it and moving on (even just a little bit) will mean that the C-Section will be dealt with and just be something that has happened in the past that is not right and totally sucked but yet you will not let it control you anymore.

I'm not a preacher nor am I a professional, but I do suffer from this disorder (as well as many other people , including soldiers from Iraq I and II and others who have gone through all sorts of horrible incidents) and I was able to relate with you not just woman to woman, but I was also able to relate to your reactions and thoughts. I am also not "cured" and there are those who have been just way too f-ed up to ever be "cured", but being able to live out of the shadows into sunlight is a light load to carry. **sorry about length. I tried to keep it short but my mind thinks to much and will not let this happen**

[Sarah Haberstich]

If I weren't at work, I'd be bawling right now. Thank you so much for fighting the good fight for all of us who hope for a VBAC--you know that's my plan as well next time around.

I can't wait to see you and give you a big hug and meet the new little bugger. Yay for John for staying strong, yay for you for staying strong, yay for doulas helping couples stay strong. Hopefully we'll be on our way to having a 2nd one sometime soon to keep our families on track with one another.

I miss you much. Congrats.

[ivymae]

A friend linked me over, and I am teary reading your story - so proud of you, but also so angry that you had to fight. Congrats on your little guy, and you VBAC!

[Suebob]

Holy cats, woman, you are a tower of strength. So glad you and Jules are doing well. What a battle story!

[Jen]

You are so awesome! So many women would have crumbled, which is understandable, but you stood strong. I wish every woman birthing in a hospital could read your story so they could have a blueprint of how to manage those oh-so-helpful medpros!

[schmutzie]

You've been featured on Five Star Friday:
http://tinyurl.com/3zpnmt

[moonmidwife]

You are amazing!!!! I am a VBAC mama too (and then an HBAC) but I didn't have to deal with any of this. You are a joy and inspiration

[Bebunu]

All I can say is wow! I am so amazed by your strength and determination.

Congratulations on your new baby boy.

[Roxanna]

Congrats on your VBAC, I was linked here for another site, what a marvelous story and one I'm sure would have been extremely similar to my own had I not had a wonderful OB staff my first time around with a 120+ hour labor. I can't believe you were so strong to stand up to everyone while being in labor, what an inspiration.

[Chapter Director]

Congratulations on your VBAC! Would you please email me as I would like to know what ICAN chapters you called, so I can follow up with them, I'm the Chapter Director for ICAN. I apologize sincerely on behalf of our mother-volunteers that did not return your call, and I assure you that we work to keep this from happening.

[Jenn R.]

Congrats! I am so shocked that your Dr. actually admitted (probably by mistake) that part of his motivation in wanting to do a cesarean was that he had been in the hospital all day and was tired of sitting around. If he's tired of sitting around, here is a thought:

Get a different profession.

You did a great job, sorry it had to be so stressful! Enjoy your baby, don't strain your back!

[Molly]

Congratulations! You sound so triumphant! What a great job. I must say it seems almost like a miracle to me that you managed to triumph and have a vaginal birth when you were dealing with so many pressures and hostile situations. It is incredible what women's bodies can do, even when faced with serious challenges working against them.

Best wishes and congratulations again!

Molly

[molly]

Congratulations, in a BIG way! It takes immense courage to do what you feel is best for you and for your child in the face of that kind of pressure; you and your husband really are inspiring.

[Kelly]

My friend sent this story to me, because I was her doula & her labor was about 33 hours... yours was 5 hrs. longer & all I can say is WOW!!!
You are a real go-getter & isn't KNOWLEDGE a powerful motivator??!! I am so glad you were informed. Without that info, you would have been cut again, for sure!!
These two comments struck me as profound:

******He said something about him having been there “all day” and wanting to go home, so I told him he better go on home and come back to check on me in the morning because I wasn’t going to end my labor just because his day was over. ***********
- good for you!!!

********He said that my uterus – I kid you not – “just might not work” so I needed to have a c-section. He said I’d had enough time and my “trial of labor” had failed. He said it was a case of “failure to progress” at which point I shot back “No! It’s a failure to WAIT.” *******
-That is smart, smart, smart!

Your story has once again, after being at 5 vaginal births, one a VBAC, made my faith in women's bodies/minds to connect with their child & do what they need to have their baby in the least harmful way possible!!

Thanks for sharing!
Sincerely,
Kelly Kravitz, CD
Doula Surround, VA

[KEM]

WOW!!!! You are an inspiration to all VBAC mamas out there! I hope I have as much courage as you displayed in that hospital!!!

Congrats on your beautiful baby!

[Sara]

I'm in doula training right now, and I'm headed for my workshop to become certified this weekend. Would it be ok with you if I shared this story with the women of my workshop? More of us should feel the power like your Holly did. What an amazing story. The three of you (John, yourself and Holly) all worked toegether to create such an amazing birth. Happy baby moon mama!!

[Jenrose]

I'm glad you were able to birth vaginally, and SO SO SO VERY angry you had to fight so much. That kind of stupid battle is exactly why we had our second baby at home. Funny thing... it turned out that anything they could have done for us in the hospital would have increased the risk, not decreased it. And yeah, I had a couple docs give me "dead baby" stories when I told them I was doing it at home.

[Danielle]

Wow! Congratulations mama! How wonderful that you fought for yourself, your baby and the birth you wanted! You should be proud.

[Aimie]

Thank you so much for posting your birth story! I really appreciate you sharing your strength with us.

[Jasmine]

Your story has tears in my eyes and has given me hope for my next pregnancy. Thank you so much.

[Moospie]

What awesome strength you have! Congratulations to you and your family on your new addition.

[iamthediva]

Oh my God!! Thank you so much for posting this. i was completely there with you on that emotional roller coaster. I felt like shouting hooray at the end! I've never been prouder of a complete stranger in my life. C-section is my biggest fear right now, and i'm so inspired by the way you and John stood up for your right to birth the way you want! and with such aggresive Medical practitioners, you deserve a medal!!

[Julia]

I just wanted to thank you so much for posting this story. I had my second child, an unmedicated in-hospital VBAC, on 5/19, and your story is everything that I was afraid of about a hospital birth and a VBAC, and you are just SO STRONG I can't even believe it. You are such an inspiration, and so amazing. Congratulations on your son and your birth.

[Marile Haynes]

Hi! I'm Holly's mother and I just wanted to say how inspiring and awesome it was to read your birth experience. It amazes me how much pressure the medical profession puts on laboring women - especially the scare tactics. Holly was born in a hospital but her two younger siblings were both born at home. I count myself fortunate to have been able to give birth twice without all that pressure and interference. Once again, you did GREAT! Congratulations on your newborn!

[Sonja]

You are unbelievable! I can't even really put into words how happy I am for you for fighting hospital procedure the way you did. I'm blown away! Congratulations!!!

[Jenn]

Congrats on the VBAC...and your new little guy! The one hospital in my town where women can actually give birth wont allow VBACs at all, at least that is the word on the street. Very inspiring post.

[Julie]

I'm kind of going through this same ordeal. Although I'm 35wks pregnant and not in labor etc. I'm still battling with my doctor about this VBAC. Your story is COMPLETE inspiration because as of last night I was backed into a corner of either delivering alone at home or being subjected to an inevitable csection at a hospital.
I'm still weighing my options and definitely schooling myself in a homebirth if, come Thursday, after talking to my doctor about how she needs to change her attitude with me, if that doesn't turn out at least I know I'll for sure be safe at home- although I would rather this first VBAC to be in a hospital although the hostile environment does NOT make me feel well at all.

[Liz]

Your story is sad, amazing and inspiring all at once! It's sad how freaking hard you had to fight to get a normal birth- even though there were no solid reasons for the pressure the staff exerted on you for a C! This is what I fear when I try for my VBAC. I did not have pain relief during my labor and I think that made me more vulnerable to the pressure for a cesarean, especially when they pulled the "dead baby" card on me. Bravo to you, and thanks for a beautiful story.

[susan]

you are one strong momma! and your son is a very llucky boy to have you!

[Amy Wilson]

I just want to say that you are a hero and a inspiration to me! I am going for my 1st VBAC this October and I'm so afraid of going through what you did. But after reading this my fears have almost completely subsided. You are absolutely wonderful and have given me even more hope than I've had throughout this pregnancy. Congratulations on your VBAC and most of all on your beautiful new baby. ((hugs))

[Amanda]

You go, girl. What you wrote about being in what I like to call the "stranded beetle" position for pushing is EXACTLY what I experience with my babe. Things just happen and all of a sudden - hey! You're in the precise position you promised yourself you wouldn't be. Thank you for sharing your courage and determination with all of us - because of your story, I think I'll be a little more gutsy next time in insisting - my way or the highway!

[Emily]

Congratulations on sticking to your guns. You knew what was right and didn't let anyone make stupid decisions for you! I had a similar experience with the birth of my second son - I started as a homebirth and transported to the hospital, where I got to have a lovely fight with the doctor who thought vbacs were "never safe". :) It makes me mad as hell to hear about doctors who do such awful things to women - lying through their teeth to scare us into submission - but it is fantastic to hear about women who stand up to them. Good for you!

[Danuta]

You go girl! As Ina May says: Your body is not a lemon!

[atyourcervix]

Here are some thoughts, coming from the L&D nurse viewpoint: (do not get angry with me please, these are my thoughts and opinions!)

10am - Admission at 2cm after only 2 hours of labor - too early for admission. Could have gone home for a few hours, to labor more at home. I understand about the pain of labor - and how much it hurts (I've had 3 children), but staying at home is better when in early labor.

1pm - epidural placed - any change to the cervix? If still 2cm, this was too early for an epidural, in my opinion. Some might say yes, get the epidural. The epidural will help the mom to relax and for dilation to occur. Others say no, it's not active labor yet if the cervix isn't changing. It all depends on how much pain you're having, and how you're coping. Just know that once you get that epidural, you are open to complications and needing to have more interventions possibly. Labor can stall or stop completely after an epidural. You have an increased risk of needing labor augmented. Risk for epidural fever - which can lead to maternal infection or sepsis - which can lead to baby becoming septic.

6pm - 7cm and +1 to +2 station - normal temp, normal fetal heartrate. All good! Were position changes implemented at this point to keep cervical progress? If baby is asynclitic or posterior, extreme side to side position changes will help baby rotate, and cervical changes to continue. Bladder status? Use of bedpan or catheter? Keeping bladder empty (via Foley) will help keep baby descending, and allow the cervix to continue to dilate. Risk with Foley is bladder infection postpartum. All interventions have pros and cons.

7pm - new resident MD. 5cm. Moving backwards versus prior MD not correct in cervical exam? Woman full of FEAR - failure to progress ---- fear can slow down or even stop labor. Negative talk from MD -- more fear in woman. Discussion of pitocin. MD wanted to go home - additional stress on mother to have c/s. Discussion of being ruptured for 8 hrs. What time was rupture? 0800 when that leaking happened in the bathroom at work? How is mom's temp? Still normal? If temp is normal - no fear of infection after only 8 hrs of rupture!!!!

Time? -- nipple stim started. Contractions increase.

Midnight - family slept. Woman fearful, watching monitor all night. Fear, once again - will stall out labor.

6am - 6-7cm. Pitocin discussed by RN. More fear placed into the woman.(UGH!) What was mom's temp through the night? Was baby's heartrate good through the night?

10am - MD wants IUPC placed.

11am - MD and 2nd MD give ultimatum.

12pm - MD back. Husband arguing with MD.

2pm - contractions decreased to every 10 minutes. Once again - lots of fear in mom.

?Time - doula suggests position changes, due to possible cervical edema. Epidural level decreased -- excellent idea!

530pm - contractions stronger. 8cm -- then 9cm.

?time - 10cm - urge to push. Epidural reinjection --- not a good idea at this time, will inhibit pushing abilities.

8pm - pushing

1001pm - baby born

45 minutes later - placenta. Frankly, I'm surprised the MD waited this long for the placenta! Surprised he/she wasn't pulling on the cord to yank it out.

[TheFeministBreeder]

Thank you for the excellent play-by-play! I'm absolutely not angry at you offering your insight. I'm dying to see my medical records to see if they say anything remotely similar to this, or if it's filled with the doctor's skewed view of the events. This is VERY helpful for me.

#1 - I wanted to go home. I wanted to labor at home as long as possible (and hopefully even have the baby there), but I went into labor at work, which was a real complication. We work downtown Chicago and take the train to work - so I would have been fully laboring on a train to get home, and I honestly didn't think I'd make it there - and the hospital was only a short cab-ride away from our office. That is the only reason I went there... I couldn't stay where I was, and home was too far away. But seriously, the hospital is the LAST place I wanted to be.

#2 - I'm fully convinced that I needed to start pushing right after I got to the hospital. No, I was not fully dilated, but my bodies urge to push was unbearable and I believe it was telling me something. I couldn't not bear down with each contraction. I mistook that as a reason to get numbed up, when I really just should have let my body do what it needed to do.

#3 - MD WAS yanking on my placenta. It was HORRIBLE pain. I didn't know what he was doing to me but it hurt like crazy, and I was begging him to stop and leave me alone. He finally stopped and backed away, and I just cuddled my baby until I felt another contraction and swish! - out came the placenta.

[atyourcervix]

You should request your full medical records. They may or may not help give you answers to your questions. I can fully understand your desire to want to stop the pain, when you are feeling such a strong urge to push. It almost sounds like the baby's head was very far down in your pelvis, straight from the beginning. It is almost impossible to try to stop from involuntary pushing when the head is so low. Been there, done that! That happened to me during my 2nd labor, starting at 7cm. Total involuntary pushing. Could NOT stop it.

I can understand the desire to not consent to pitocin augmentation. However, and I don't know if this was suggested, sometimes just running low dose pitocin through the night, or over several hours will help augment the current contractions, and allow your body to pick up the pace with the contractions, and help dilation progression. Like I said before, once you go forward with an epidural, the clock really is ticking, due to the risks involved with prolonged use of an epidural. You really need to do something, at some point, to work at keeping labor progressing. Nipple stim, low dose pitocin, position changes, turning down the epidural - something.

[TheFeministBreeder]

I was 100% against Pitocin because I knew the data on Pitocin/augmentation and Uterine Rupture in a VBAC. Pitocin is contraindicated in a VBAC. I did not want to do anything that would compromise my VBAC plans.

I wish someone had told me that starting the epidural would put me on a clock. I knew I didn't want to be "watched" and that I wanted to labor for as long as necessary. The problem is that nobody tells you the risks/benefits/alternatives of ANY of these procedures. It's just "here's what we're going to do" and that's that. Honestly, I just couldn't take them insisting on asking me where I work when I was in the middle of a contraction. Here I am, trying to move around, trying to labor, and the nurse is insisting that I answer the hospital's stupid banal questions about my address and place of employment when I can't even breathe (let alone think or talk). I was pre-registered too!!!!

I once read a blog where a woman said "Epidurals are for putting up with the hospital." I'll never think of them (or hospital birth) the same way again.

[atyourcervix]

Pitocin is actually not contraindicated with VBAC. It's the cervical ripening agents (prostaglandin gel, cytotec, cervidil) that are contraindicated with VBAC. The cervical ripening agents have less control over the dosage and being able to stop them, once they are placed. Pitocin, however, has a wide range of dosage, and is metabolized very quickly from the body once it's stopped. I believe it's about 7 minutes via the intravenous route. Pitocin with VBAC is possible - but is used very lightly and judiciously.

[TheFeministBreeder]

I think that is a matter of opinion because I have read differently. When I'm on my computer at home I will locate my sources. In fact,some doctors and hospitals in this area have strict policies against using Pitocin in a VBAC candidate. I was given a copy of these policies when I was interviewing potential providers for my next pregnancy.

Also, I'm still asking the question: why not remove/decrease the epidural when it's clear that it has stalled a labor - instead of throwing more Pitocin (and an eventual c-section) at the problem? In my business, if we know something is making a mess out of something, we fix what's broken. We don't continue to pile other "treatments" on top of something until it breaks the whole machine. Why can't any medpros answer this question for me? What is the purpose of causing a c-section when you can combat the problem by simply removing the known source of the problem? I don't see any possible justification.

[atyourcervix]

I had answered this question in my comments in my blog: we don't turn down epidurals because the majority of the women that I offer this to are terrified of the pain, and do not want to feel that pain again. Even if it's just an increase in the pressure/pain, but not full blown labor pain again. It's the mentality of the patient population that I serve: they expect full 100% relief of labor pain with that epidural. If you take away their pain relief, or offer to take away part of their pain relief, they would rather have a c/s.

[atyourcervix]

Also, here is a recent analysis of induction agents and uterine rupture with VBAC (I have the full PDF file if you would like to read it):

MECHANICAL LABOR INDUCTION AND VBAC

There is limited information detailing the risk of uterine rupture associated with the nonpharmacologic or mechanical means of labor induction in women with a prior cesarean. More specifically, there are no reports of risks associated with membrane stripping or amniotomy. Intuitively, by consideration of the mechanism of action, stripping of membranes and amniotomy would not suggest an increased risk of uterine rupture compared with spontaneous labor among these patients.

Four studies are found in the literature describing the use of a transcervical Foley catheter for induction of labor in a patient with a previous cesarean. The most recent investigation, by Bujold et al 17 in 2004, describes a review of 2479 patients who had a trial of labor after a prior cesarean delivery. Of these, 1807 patients had spontaneous labor, 417 were induced by amniotomy with or without oxytocin and 255 had labor induced by placement of a transcervical Foley catheter. The rate of successful vaginal delivery among the 3 groups was significantly different: 78% versus 77.9% versus 55.7%, respectively. The rate of uterine rupture was not increased: 1.1% versus 1.2% versus 1.6%, respectively. There was also no difference in the rate of scar disruption noted at the time of cesarean for a failed trial of labor. These authors concluded that labor induction using a transcervical Foley catheter is not associated with an increased risk of uterine rupture when compared with spontaneous labor. However, the rate of successful VBAC after mechanical cervical ripening with a transcervical Foley catheter seems to be lower than cervical ripening with other agents.17 Another concern is that despite its size (2479 patients), this review still lacks substantial power to detect true differences between these induction techniques.
PHARMACOLOGIC LABOR INDUCTION AND VBAC
Oxytocin

Oxytocin is the pharmacologic agent used most frequently for induction of labor. A systematic review of 7 studies of labor induction with oxytocin compared with spontaneous labor among patients with a prior cesarean found no significant difference in the incidence of uterine scar disruption. Of the 8572 women reviewed, 1163 received oxytocin for labor induction whereas the remaining labored spontaneously.18 Separation of the uterine scar was experienced by 0.83% and 0.62% of the patients, respectively (OR: 1.43; 95% CI 0.76, 2.69) (Table 1). On the basis of this review, oxytocin is believed to be relatively safe for induction or augmentation of labor in women with a prior cesarean.
Prostaglandin E2 (Dinoprostone)

Sanchez-Ramos also performed a meta-analysis of investigations detailing cervical ripening and labor induction in patients with a prior cesarean. Of 19 studies reviewed, only 1 was a randomized controlled trial. The incidence of uterine scar disruption, including symptomatic uterine rupture and scar dehiscence, among pregnancies that used prostaglandin E2 (PGE2) (dinoprostone) for cervical ripening was 1.65%. More specifically, 10 studies compared the incidence of uterine scar separation among 1682 PGE2 exposed patients and 11,097 patients who entered labor spontaneously. There was no difference in scar disruption among women who received PGE2 for cervical ripening compared with those who were admitted in spontaneous labor (1.6% vs. 1.23%, OR: 1.46; 95% CI 0.96, 2.22) (Table 1).18 It is noted that the rate of uterine rupture (1.23%) associated with spontaneous labor in this meta-analysis is relatively higher than in other published data. Supported by subsequent studies not included in this meta-analysis, the pooled data suggests that cervical ripening with PGE2 in women with a prior cesarean is also a relatively safe option.
PGE1 (Misoprostol)

Misoprostol (PGE1) has documented efficacy and is inexpensive and convenient for use as a cervical ripening agent.19–23 When compared with placebo, misoprostol is associated with decreased oxytocin requirements and achieves higher rates of vaginal delivery within 24 hours. Many studies also demonstrate similar results when compared with PGE2 preparations.24

When given in doses of 50 mcg or more, misoprostol has been associated with an increased rate of uterine tachysytole and meconium passage.19 Some studies have also suggested an increased risk of cesarean due to persistent hyperstimulation.25 In contrast, clinical investigations using 25 mcg of misoprostol have not described increased rates of the above adverse events and have proven to be as effective for labor induction as PGE2.26

In the Sanchez-Ramos meta-analysis of cervical ripening and labor induction in patients with a prior cesarean delivery, 12 reports including 355 patients attempting VBAC via induction with misoprostol reported a 4.5% rate of uterine scar disruption (Table 1). A similar result was also identified among 3 studies comparing preinduction cervical ripening with misoprostol to spontaneous labor.27–29 The incidence of uterine separation was higher in women who received misoprostol than in those admitted in spontaneous labor (5.4% vs. 1.3%, respectively).18 In addition, the rates associated with misoprostol cervical ripening and induction are significantly higher than rates reported with other prostaglandins or oxytocin.

Probably more revealing are recent investigations describing these risks among larger patient cohorts attempting a trial of labor after a prior cesarean. In 2001, Lydon-Rochelle et al 14 in Washington state described a population-based retrospective cohort analysis of 20,095 women with one prior cesarean. The investigation assessed the risk of uterine rupture for deliveries in the following categories: spontaneous onset of labor, induction by prostaglandins, induction by other means, and repeat cesarean without labor. The authors found that among women with one prior cesarean, the risk of uterine rupture is higher with induction of labor compared with repeat cesarean in the absence of labor. More specifically, uterine rupture occurred among 0.16% of patients having a repeat cesarean without labor. With spontaneous labor, 0.52% experienced uterine scar separation compared with 0.77% induced without prostaglandins and 2.4% in women induced with prostaglandins. When compared with the risk for women with repeat cesareans without labor, uterine rupture was 3.3-fold more likely among women with spontaneous labor (Relative risk (RR): 3.3; 95% CI 1.8-6.0), 4.9-fold more likely with induction of labor without prostaglandins (RR: 4.9; 95% CI 2.4-9.7) and 15.6-fold more likely with induction of labor with prostaglandins (RR: 15.6; 95% CI 8.1-30.0) (Table 1).14

More recently, less ominous results were found in a multicenter prospective observational study of more than 17,000 deliveries after a prior cesarean at 19 academic centers. This investigation was published by Landon et al 12 for the MFMU Network. Spontaneous labor was associated with a 0.4% rate of uterine rupture. With augmented labor, 0.9% of patients experienced uterine scar rupture (OR: 2.42; 95% CI 1.49-3.93) and 1.0% of induced patients were similarly affected (OR: 2.86; 95% CI 1.75-4.67). When prostaglandins were used for labor induction, the rate of uterine rupture was 1.4%. When compared with the risk among women having an elective repeat cesarean, the risk of uterine rupture was 2.42-fold more likely with augmented labor, 2.48-fold more likely among patients who were induced without prostaglandins, and 3.95-fold more likely with induction of labor with prostaglandins (Table 1).12

The study by Lydon-Rochelle is limited by its retrospective nature. The data were derived from vital statistics and administrative records. Labor was considered to have been induced with prostaglandins if “induction of labor with prostaglandins” was marked and the corresponding ICD-9-CM code was used. An alternative ICD-9-CM code was used to reflect “induction of labor” without prostaglandins. The authors have minimized the risk of inaccurate documentation by using the corresponding ICD-9-CM code. Nonetheless, with birth record data, there is always the concern of inaccurate coding or incomplete information.

The results favored by these authors are those of the MFMU Network study. Although the investigation does not identify the specific induction agent for individual uterine rupture risks, the data is strengthened its large size, the multicenter design, and the prospective process of data collection by trained obstetrical research personnel. In this study, augmentation of labor with oxytocin and induction of labor with and without prostaglandins were associated with a significantly greater risk of uterine rupture than was spontaneous labor without the use of oxytocin. The highest risk was associated with labor induction by prostaglandins. The risk of 1.4% was substantially lower than the 2.4% found in the retrospective vital statistics data reported by Lydon-Rochelle and significantly lower than the results reported in the meta-analysis of Sanchez-Ramos (Table 1).

In conclusion, the presence of a uterine scar in a pregnant uterus is not without risk. Both elective repeat cesarean and spontaneous labor can be associated with uterine scar rupture or dehiscence. The data available, however limited, deem oxytocin and PGE2 to be relatively safe for labor induction. As discussed, we feel that the large prospective data from the MFMU Network is the most accurate analysis of the inherent risks associated with labor induction in a scarred uterus. These conclusions are made despite the inability to differentiate specific induction agents.

[TheFeministBreeder]

There is a woman in my ICAN group requesting induction rather than a 3rd cesarean - no doctor in the area will agree to induce her. I'll pass this information along to her and see if this helps her case at all.

[Amie]

Not that it would help that woman's case, and it's probably too late now, but I've had two oxytocin induced VBACs which my OB based on the same information above. I've truly found that the medical response to a VBAC is very dependent on what area of the country you're in. Fortunately for me I've had very understanding and helpful OBs.

Congratulation to you on your strength in getting the healthy VBAC you deserved. Labor alone can be pretty overwhelming, but having to go through it with so much opposition is very impressive.

[labortrials]

My goodness, yes! I can't believe all you went through and still... success. My hat is off to you.

I forwarded this to my husband so he'd kind of know what we might be up against. I'm ruled out of homebirth because I'm pregnant with twins, and I'm starting to lose faith that the doctors will support my choices. There's a significant chance that my doctor will be unavailable to me and I'll be at the mercy of some doc I've never even met.

I know that Wagner's "Born In the USA" has a table showing that the rupture rate goes from 1 in 200 to 1 in 100 with oxytocin augmentation. I'm off to the Cochrane database to see what else I can find.

[TheFeministBreeder]

Now I remember where I got my "pitocin is bad" information from

Specifically Wagner produced a table in Born In the USA which provides sample rupture rates:
1 in 33,000 – woman with unscarred uterus
1 in 200 – VBAC without augmentation or induction
1 in 100 – VBAC with oxytocin augmentation
1 in 43 – oxytocin induction
1 in 20 – Cytotec induction

Pitocon+VBAC = evidence of increased risk of rupture.