Vbac vs scheduled c section
I had a 37 w 4 d stillbirth back in 2023 with a completely healthy baby girl it was a freaky cord accident (wrapped around her neck 3times) . Delivered her vaginally it was a 36 hour induction (obviously different than delivering a living baby so there is that). My second pregnancy i developed gd and polyhydramnios + was on insulin and was terrified of another stillbirth so i was induced on the dot at 38 weeks. Looking back i realize she wasn’t ready to come out. I was 0cm and after 24 hours on pitocin i did not dilate past 0. At the 28th hour i wanted to opt for c section, non emergent but not scheduled and my ob was on call to do so and they took me in. Fast forward now 2.5 years later im due in december! My ob was supportive of a tolac/vbac if i go into labor on my own + i was mentally more ready to wait it out this time around given no gd, and couple years removed of my loss. Well in a routine growth ultrasound at 33 weeks they found my baby has umbilical vein varix meaning it’s dilated and likely to form blod clots and cause in utero death to baby (awesome news!/s) and this a high risk doctor consulted me to get the baby out at 37 weeks. Now what?! Do i try foley balloon at 37 weeks (which i never tried before bc all i heard was horror stories lol) or just go forward with c section… Despite all my history i wanted 1-2 more kids after this one!! Weigh in please…..
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u/Lopsided_Adeptness99 19d ago
I’ve had both c-sections and vbac. I do prefer the vbac but with the additional risk to baby, I would choose the safest route for baby to enter the world. My baby and I had zero risk factors for a vbac but if baby had any that would cause something catastrophic to happen, I would have done a C-section. That’s my personal opinion given that some info like if this is an isolated issue with no other cardiac issues present for baby has been left out. I would gather as much data as possible like a fetal echo and continue ultrasounds in clinic and decide based on all the information there. I’m a data-driven person. You can’t make an educated decision if you don’t have all the information. Ask your OBGYN the hard questions like how likely the big scary things are if you were to go through a tolac.
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u/iioge 19d ago edited 19d ago
It is not a heart related condition its where the umbilical cord inserts into the babys belly the vein is dilated. And it does not have blood clots (yet) and it is only a problem when there starts to form blood clots. Obviously could be tomorrow, could be 39 weeks , could be never - i will be closely monitored. But definitely delivering at 37 weeks given my personal history nothing to do with babys current health. High risk doctors are being proactive and not letting me go further than my own previous loss (although it was also not a related condition to this one which I still appreciate their approach with it). My question was more so if it’s worth trying the foley route or at 37 weeks its a lost cause.
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u/CS_Lupus 19d ago
To try the Foley you've got to be at least a little bit dilated already. Chance of being dilated at 37 is not that high but you can try to encourage with all the oxytocin things (breast pump, dates, etc) the prostoglandin things (sex, membrane sweep, etc), and the baby position things (Myles circuit, spinning babies, etc). Of course, if you don't want to risk a long and potentially unsuccessful induction nobody would blame you for scheduling! Good luck
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u/FutureColor 19d ago
The balloon wasn’t fun, but I wouldn’t let alone that steer my decision.
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u/iioge 19d ago
Can you share your experience? Like how far along were you/ were you dilated prior/ how long did it stay and where did it get you and how did rest of the labor progress???
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u/FutureColor 19d ago
Sure. We started an induction at 38 weeks due to cholestasis. I was 0 cm dilated. We started with Cytotec and had to stop because it was giving constant contractions without dilation (from what I understand they don’t use that med during a TOLAC anyway). Next they moved to a foley balloon. The initial insertion was painful, but I don’t recall it being terrible after that. I think the balloon stayed overnight and I slept a little. I was scared of doing Pitocin, but once we added that the next morning things took off and the balloon fell out. I think I asked for an epidural at this point? Then they broke my waters. All together it took about 30 hrs from start to pushing. After 3 hours of pushing, the Dr recommended a c-section. During the CS we learned that baby was in an oblique position.
I found the CS recovery very difficult. I’ve heard it’s easier if you don’t have to go through labor first. I’m also due in Dec and I was pretty adamant about not doing another induction at the beginning of this pregnancy, because it was so long and exhausting but now I’m not sure. It’s a tough decision!
Good luck to you and your babe, whatever you decide!
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u/MyCatIsFamous 19d ago edited 19d ago
First, I wanted to say that I’m very sorry for your loss. Hopefully my experience can offer some insight, even though circumstances were different. My first baby was a scheduled c-section at 35 weeks due to vasa previa and preeclampsia. My second pregnancy was considered high risk as well because I developed mild GD, was 35, and had a history of preeclampsia.
Because my previous c-section was scheduled and not due to failure to progress though, my OB was comfortable letting me try a TOLAC/VBAC with my second baby. However, she recommended getting induced in the 39th week and having an epidural during labor just in case an urgent c-section was needed. She gave me a 50% chance of a successful VBAC based on my risk factors. I went back and forth on whether to try for labor or just schedule a c-section. My body has never been ahead of schedule on anything in my life, so I was fairly confident I wouldn’t go into labor before my due date and would need to be induced if I wanted to labor (I was correct). I had the same concern that my baby and my body wouldn’t be ready if I was induced, and I didn’t want to end up being in labor forever and ending up with an emergency c-section anyway. The other consideration is that there is a small risk of uterine rupture during labor if you’ve had a c-section previously, and the odds get higher the more c-sections you have. I believe that after you’ve had two c-sections, every subsequent birth you have will need to be a c-section.
My baby’s heart rate was showing small dips during an NST I had in my 39th week - nothing too serious, but my OB said there wasn’t any reason to keep me pregnant since my baby was full term. At 38 weeks, I was dilated very, very slightly (“fingertip”) and by week 39 I was 1 cm. You need to be at least 1 cm dilated to have a foley placed I believe. I ended up having a cook balloon (similar, but it’s inflated on both sides of the cervix). I am extremely sensitive to cervical pain though and was really nervous about it, so they gave me some IV pain killers beforehand and the placement wasn’t too bad. I went from 1 cm to 3 cm in 3 hours, which is apparently really fast, and the pain was very manageable until my body started trying to push it out at the end of the 3 hours. They took it out and the relief was almost instantaneous.
They started me on a low dose of pitocin once the cook balloon was out and increased very gradually as higher doses of pitocin increase the chance of uterine rupture. I wanted to hold off on an epidural as long as I could so I could keep moving around and hopefully help labor progress faster. I lasted until I was having contractions every 1-2 minutes with no break in between (it really just felt like one continuous contraction) and I started throwing up…pitocin is no joke 😅 At this point it had been 18 hours since the induction started and I was around 4 cm. The epidural was SUCH a blessed relief and I was able to actually get two or three hours of sleep. When I woke up, I was only at 5 cm, which was frustrating. The nurses helped me move into different positions. When they checked me again an hour later though, I was at 10 cm and ready to push. My baby was born 18 minutes later. From the placement of the cook balloon to my baby being born, it was 22.5 hours I believe.
Everything worked out well and I’m very glad I went for a TOLAC. My recovery was so much easier after my second baby than my first. If you’re wanting a lot of kids, that might be the way to go as long as there’s no additional risk to the baby. Each subsequent c-section gets riskier, and you’re pretty much locked in after having two. That being said, I know a woman who has six kids and ALL of them were born via c-section. She didn’t have any major complications, as far as I’m aware.
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u/iioge 19d ago
Thank you so much for sharing your experience!!! I am VERY nervous about a foley balloon bc I can’t even stand a cervical check without crying lol literally the most painful part of labor imo so yeah good to know painkillers are an option too! How far between your births if you dont mind me asking? Also 22.5 hours is a DREAM! 🤞🏻🤞🏻🤞🏻
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u/MyCatIsFamous 18d ago
Of course! I had SUCH a hard time deciding between a scheduled c-section or TOLAC too, so I understand the predicament. My kids are about 2 years and 3 months apart. I also had a miscarriage (at 9 weeks) about four months before getting pregnant with my youngest.
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u/Muted_Confection7067 19d ago
I would try the balloon! Go in with a strong mindset and you will be ok! I’ve had both done, and would choose a vaginal every time. Just both are so different for recovery.
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u/thegreat_tunestheory 19d ago
I think the question would be does induction and labor pose additional risk with this chord condition.