Posted by My OB said WHAT?!?.
Jan
11
Posted by My OB said WHAT?!?.
“I’m Going To Schedule Your Cesarean Section For 38 Weeks.”
“I’m going to schedule your C-section for 38 weeks.” - OB to mother at 8 week prenatal visit after agreeing to a VBAC at the pre-conception appointment.
There are 39 comments to this post.
Excuse me! First off I’m here for a VBAC and YOU ARE FIRED! Secondly 38 weeks is too early. Have you completely missed the March of Dimes warnings? They don’t want you doing scheduled c-sections before 39 weeks. Now me personally, I won’t do a c-section before 42 weeks, as in if I don’t go into labor on my own I will not be induced, but will volunterily submit to a c-section once I’ve hit 42 as measured by 40 past conception. That is my policy, and since it is my body, I guess you just lost yourself a patient. Talk about bait and switch! (Can you see the steam rolling out of my ears?)
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Suzanne Reply:
January 11th, 2012 at 9:22 am (Quote)
Just curious – why would you not be induced? 
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Robyn Reply:
January 11th, 2012 at 9:50 am (Quote)
If you’re shooting for a VBAC, induction is dangerous as it’s much more likely to cause uterine rupture.
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Details Reply:
January 11th, 2012 at 10:30 am (Quote)
Robyn is right. Pit leads to ruptures. Nope Nope Nope. I would not go there! Glad I didn’t go there. Glad I had my babies when I did and with the doctor that I did. Doctors now are so pit happy they foget the risks.
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MomTFH Reply:
January 11th, 2012 at 12:05 pm (Quote)
Close. It’s induction with Cytotec (misoprostol) that is strogly associated with uterine rupture. Pitocin is used for augmentation of labor, not induction, and isn’t as clearly linked to rupture.
But yes, 38 week section bad, induction after cesarean bad, and doctor going against care recommendations and stated wishes of patient extra bad.
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Sheva Reply:
January 11th, 2012 at 12:22 pm (Quote)
I was induced twice with Pitocin. From zero contractions to birth, entirely with Pitocin.
Check this out:
http://www.aimsusa.org/obstetricdrugs.htm
Two notable quotes:
“PITOCIN has been approved by the FDA for the medical induction and stimulation of labor.”
“Maternal deaths due to hypertensive episodes, subarachnoid hemorrhage, rupture of the uterus, fetal deaths and permanent CNS or brain damage of the infant due to various causes have been reported to be associated with the use of parenteral oxytocic drugs for induction of labor or for augmentation in the first and second stages of labor.”
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MomTFH Reply:
January 11th, 2012 at 12:40 pm (Quote)
Don’t really want to get in a big argument of this, but it’s induction with Cytotec that is linked to uterine rupture in the literature. Pitocin is not normally used as a sole induction agent, unless the cervix is already favorable. Usually some sort of induction or ripening agent is used first, such as misoprostol or cervadil. But yes, technically some practitioners will do just Pitocin. It’s not common standard of care where I am.
The literature on risk with oxytocin augmentation or induction is inconclusive and needs more research. The trials have not shown a statistically significant increased risk. If one is generally talking about risk of uterine rupture with induction after cesarean, the drug with the clear, significant association with rupture is misoprostol.
Not saying TOLACs should all be given Pitocin, but the general recommendation in the literature is that if it is indicated, it can be used. However, misoprostol is definitely contraindicated.
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Rachel Reply:
January 11th, 2012 at 1:21 pm (Quote)
I was induced twice as well with only pitocin and the first time was at 35-5 and they never checked me once to see if I was favorable and nether time was I ever given anything else
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Details Reply:
January 12th, 2012 at 9:00 am (Quote)
You are absouletly right that cytotec is very strongly linked to uterine rupture. However, you can still find doctors who use it even on TOL moms. You can also find doctors who think they are doing you a favor by giving you pit at 40 weeks rather than letting nature take its course all the way to 42. There are a lot of people out there who think they have it all figured out and can play games with peoples’ lives.
Of course it needs more study. What doesn’t? Where are you going to come up with 2000 VBAC women who may or may not need induction or augmentation for a double blind study? You aren’t! The best you are going to do is a review of the literature which will be full of women who have 7 other variable that havn’t been controlled for. Too bad we don’t have that maternal results review the English have.
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Toni Reply:
January 11th, 2012 at 12:49 pm (Quote)
Any labor inducing/augmenting drug is associated with an increased risk of rupture (for everyone, but most notable with VBACs since they already have a scar). Misoprosol appears to be the riskiest method, folowed by pitocin, then PGE2 (or PGE2 then pit, depending on who you talk to).
Pit is less harmful when used to augment, rather than to induce (double the risk of rupture vs quadruple, respectively), but still potentially dangerous.
So I can fully understand opting for RCS rather than inducing (at 42 weeks). Though, so long as misoprostol is not used, I could also understand attempting to induce (being VERY carefully monitored, of course).
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Jade Reply:
January 11th, 2012 at 11:42 pm (Quote)
What about non drug induction? Foley bulb? Stretch and sweep? cervical dilators (usually made of things like seaweed which manually expand/dilate the cervix)
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Toni Reply:
January 12th, 2012 at 7:18 am (Quote)
Foley catheter alone is considered a “resonable option” (tho the studies showed an increased risk of three times, BUT most of the women in the study also recieved oxytocin, so that study isn’t very reliable). Overall, mechanical methods of dialation are “reassuring”, but there are limited studies. Some good info on VBAC rupture rates under various circumstances:
http://emedicine.medscape.com/article/275854-overview
Long, but covers a lot of situations.
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Cara Reply:
January 13th, 2012 at 3:46 pm (Quote)
Those don’t carry the risk of uterine rupture, but there are some other issues they can present instead (plus they are not always a method for induction, but usually for ripening the cervix for pitocin). Most notable is risk of infection or premature membrane rupture. Small risk of cord prolapse if the water breaks with baby still “floating” and not engaged in pelvis. Possibility of cervix injury or scarring which is usually more of a concern during the next birth, when it could hinder dilation/effacement.
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Cara Reply:
January 13th, 2012 at 3:53 pm (Quote)
Partially right. Pitocin is the leading drug used for chemical induction, as others have said. It is definitely associated with uterine rupture, as is any substance which could cause a uterus to hyperstimulate (yes, even the body’s own oxytocin if stimulated too much!) The risk of UR for a first time mom being induced with pitocin is 2% and the risk increases slightly with VBACs. However you are correct that cytotec is much more of a rupture risk, due in part to its unreliability…you have NO idea how much of the pill piece you’re giving a mom contains main ingredient and how much is filler, sometimes mom gets the whole dose at one time instead of spread out. You cannot remove the stimulation once it starts, just hope it doesn’t turn catastrophic. Cytotec now is used more often as a cervical ripener in the same was as prepidil or cervadil. However the reason it induces so many moms is because it doesn’t always just soften the cervix, sometimes it just turns it to straight up mush. Which allows the uterus to turn even the smallest braxton hicks contraction into a massive dilation. Not good.
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Details Reply:
January 12th, 2012 at 8:45 am (Quote)
Fascinating facts you ladies have come up with, but my last VBAC attempt was right around the time when cytotec was just coming into use in labor – thus the “glad I had my babies when I did” and my doctor wasn’t the kind to play games. Pit from zero to birth being 4 times more likely to cause trouble sounds like a big risk to me. I wouldn’t have taken that risk and my doctor wouldn’t have recommended it. If I hadn’t gone into labor on my own I would have had a scheduled c-section. Now since I’ve always gone into labor before 42 weeks, I consider THAT to be one of the really big problems here. Far too many hospitals want to evict at 40 weeks.
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Jenni Reply:
January 13th, 2012 at 6:40 pm (Quote)
The risk of uterine rupture for a VBAC is approximately .5%. With pitocin augmentation, that risk increases only slightly to .7%. It’s definitely not 4x the risk. I had a successful VBAC 2.5 years ago, with pit, and everything turned out great. I am lucky to have had care providers who were honest and discussed all my options with me (I also educated myself very well on the subject).
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When my former OB said at my 20 week appointment, “Let’s talk about getting your C-section on the schedule,” I answered, “Ok, let’s talk about it. I won’t consent to it without legitimate medical need.” I went on to have a successful vaginal birth of twins with another doctor.
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You can schedule it whenever you like, I won’t be showing up. In fact, I won’t be back. How about you have someone get my records ready for me to take to another doctor.
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Emilee Reply:
January 11th, 2012 at 8:53 am (Quote)
That’s what I was going to say! Go ahead and schedule it, and have fun in an empty operating room when i do NOT show up!
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road2vba2c Reply:
January 11th, 2012 at 9:37 am (Quote)
Be careful, he may just schedule it and not tell you when it is… http://myobsaidwhat.com/2011/12/17/we-can-schedule-your-cesarean-and-not-tell-you-when-it-is/
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By the way, since you lured me here under false pretenses, you will receive no payment for this visit. I’ll also be contacting my insurance company and instructing them to deny payment. You’re welcome to press the issue, but in any other industry, people are only paid for service rendered, and the only service you’ve given me is lip service. I can get that anywhere. You’re very fired.
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This happened to my friend, except it wasn’t early in her pregnancy… it was at like 36 weeks, they told her that they wanted to schedule her for a c/s on her due date and would only “do” a VBAC if she went into labor first. It just infuriates me!
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This is mine! Here is the background. When I was pregnant with my son I developed placenta previa and has hospitalized at 27 weeks because I was hemorrhaging. After 11 days they could no longer stop the bleeding and he had to be born via c-section at 29 weeks. The epi didn’t take and I had to be out for the section. My last words to the OB before I went under were “I want a VBAC next time so do what you need to do to make that possible.” My son was born at 3lbs 4oz and had a 52 day NICU stay. I’m happy to report he is healthy 3 years old and has no linger effects from his early delivery.
When we decided to have another baby I went back to my OB for a pre-conception appointment since I was “high-risk” to discuss everything. She went over my surgery notes then and told me should was about to make a low-transverse incision with my son so I should be able to have a VBAC no problem and to call to get scheduled to come in as soon as I found out I was pregnant.
Fast Forward 3 months, I’m just 8 weeks along and moments after she tells me everything so far looks good with this pregnancy she tells me “Let’s schedule for c-section for 38 weeks.” My jaw dropped to the floor.
When I said that just months ago you agreed to this she threw at me “Well now looking at things and I’m just not comfortable letting you go longer than 38 weeks. You uterus never stretched fully since you son was born at 29 weeks. If you go into labor on your own prior to 38 weeks you can try for a VBAC, but it would be really risky.” Total bait and switch!
Plus, after being a preemie mom I know that forcing a baby to be born prior to 39 weeks at the earliest without a real medical need is just asking for another NICU baby and I was not going to stand for that.
I found another OB right away and went on to have my VBAC at 40 weeks, 4 days. It was induced, but very well done with low, low pit and ARM. I had an epi-free delivery and it only took 7 hours from when I walked into the hospital to when I had my baby in my arms.
Ideally I would have rather waited until 42 weeks (and hopefully gone into labor on my own), but induced at 40+ weeks is better than c-section at 38, so I took it as a victory.
Additionally my daughter was only 6lbs 4oz, had she been born 2+ weeks earlier she would have spent time in the NICU I have no doubt. And the NICU nurses who came down to visit me agreed.
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Miss M Reply:
January 11th, 2012 at 10:33 am (Quote)
Sorry for the typos. My VBAC baby kept grabbing the keyboard
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Details Reply:
January 11th, 2012 at 10:51 am (Quote)
Totally victory! Kiss them both for me! I’m going to do a little happy dance for you now. I really should be jeolous as all get out, but instead I want to celebrate. *Que the Snoppy music* Okay I’m done! Finally somebody gets what they want! It is about darn time. This site depresses me.
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Samantha had this to say,
Jan 11, 2012 @ 10:50 am (Quote)
She actually said your uterus didn’t stretch with your first & that put you at risk?!?! WTF? Seriously, how ridiculous is that?
Congrats on your VBAC!!!
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Rebecca Reply:
January 11th, 2012 at 11:19 am (Quote)
Makes perfect sense since if the baby had been full term she would have stretched the scar from the incision from her birth, duh.
That’s why first time mom’s are never, ever allowed a VBAC.
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Details Reply:
January 11th, 2012 at 11:38 am (Quote)
ROFLMAO First time moms aren’t allowed to VBAC!!
Then I thought about moms who have uterine surgery before their first birth. 
There is a logic there. If the scar which was made on a 29 week explaned uterus would need to stretch then scar tissue doesn’t stretch as well as regular tissue so it could be a problem BUT that is why low horizontal is safer than vertical because that lowest segment of the uterus doesn’t grow near as much as the middle and upper parts do. This doctor was looking for something to freak out over. If it wasn’t this it would have been something else. Better to get it over with early and find a good doctor in plenty of time.
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Mom of One had this to say,
Jan 11, 2012 @ 9:27 pm (Quote)
Dear Doctor,
I think the only thing you should be scheduling is a hearing test! She SAID she would be having a VBAC!!!
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Be careful, inductions often lead to having a C-Section. Here’s some helpful info on that:
http://worry-free-c-section.com/blog/2340/pitocin-induction-has-been-linked-to-having-a-c-section/
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Add Your Comment.
how horrid, OP I hope you managed to get your VBAC
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