What medical guidelines say about VBAC inductions

I am still trying to get my head around the issue of using - or not using - Syntocinon for being induced for a VBAC. (See a background story here.) My appointment with an obstetrician is coming up rapidly and I want to understand this topic as much as (reasonably) possible for when we meet.

In an effort of digging up information that may be relevant, I've been reading up on how different hospitals (and countries) handle VBAC inductions, and whether world practices differ from what is offered at Christchurch Women's or New Zealand in general. In doing so, I've looked through a fair deal of publicly shared medical guidelines. Some I have found quite helpful!

And now, in an effort of helping someone else who might be - just like me - trawling the internet in search of information, I'll try and share some of it here.

Because, look, it's one thing to read anecdotal evidence from baby forums - I know I have done a lot of it, and so have probably other women who've faced a situation similar to mine. Forums have thousands, thousands of posts on VBAC inductions.

But the thing with forums is that they're... one-sided. (Or at least can be.) People who write on forums have an agenda, a vested interest in sharing what they're sharing. As much as I am grateful to thousands of women who have left their footprints in the world wide web in form of forum posts, left in their moments of personal heartache or maybe contentment, I've also tried looking past forums and seeing what actual medical professionals have had to say.

So here's a sample of what I've read.

Canadian Society of Obstetricians and Gynaecologists, for example, says in their clinical practice guidelines that:

"8. Oxytocin augmentation is not contraindicated in women undergoing a TOL after Caesarean section (II-2A).
9. Medical induction of labour with oxytocin may be associated with an increased risk of uterine rupture and should be used carefully after appropriate counselling (II-2B).
10. Medical induction of labour with prostaglandin E2 (dinoprostone) is associated with an increased risk of uterine rupture and should not be used except in rare circumstances and after appropriate counselling (II-2B)."

That, in simple words, means that:

1) if your labour has already started on its own, then helping it along - ie, augmenting - with Syntocinon is not necessarily a bad idea,
2) if your labour hasn't started, but you need to be induced, then doing it with Syntocinon isn't really... straightforward, and
3) if your labour hasn't started, but you need to be induced, then doing it with prostaglandins is, how to put it politely... not recommended.

King Edward Memorial Hospital in Perth (which has got a VBAC success rate of approx 75%, and in world context, we are talking high!) says in their clinical guidelines that:

"The available evidence suggests that the use of oxytocin is associated with a reduced success of vaginal birth and a doubling of scar rupture/dehiscence1, 6. However, oxytocin may be used with caution in women with a previous caesarean section, following discussion with the obstetric consultant on-call for Labour and Birth Suite1."

In a nutshell, it's sort of what Canadians were saying above, and that is: use Syntocinon if you really, really have to, but... bear in mind that it's really not a good option overall. 

The Royal Women's Hospital in Melbourne seems to, also, be very similar in their approach:

"There is a 2-3 fold increased risk of uterine rupture with induction or augmentation of labour. The risk of C/S is increased 1-5 fold with these procedures. Induction or augmentation of labour should only be considered with consultant involvement and a clear understanding by the woman about the increased risks."

There's more, too, but after a while they sort of start repeating themselves.


So overall - and the more so the more I am reading about - being induced with Syntocinon is really not that... flash of an option, really. Not whilst being a VBAC.

Which basically just leaves me with a question of why exactly they think I need to go by the time I am 40 weeks pregnant, considering that I have what they refer to as "excellent glycemic control". Once that is answered, choosing whether to be induced or not to be induced will be easier. I hope.

But it's not a question I've been able to find an answer to on the internet, so for that, I really just need to wait for that appointment, and that talk, and... until then, I'll just keep on doing what I'm doing.

Fun times! =)

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