I am currently 38 1/2 weeks pregnant. On my last trip to the doctor he suggested that if I did not deliver before my due date I should prepare myself for a scheduled c-section. His reasons were: 1) size of baby-my first was 9 lbs 6 ozs. and he is assuming this one will be bigger. (He has not done an ultrasound to determine size of baby) 2) use of Pitocin too dangerous on VBAC. (my first c-section was due to failure to progress. I was at 41 1/2 weeks when they augmented me w/Pitocin. I never dilated past 4 cm. The doctor later told me that the baby never turned. But CPD was not mentioned)
I believe he is being overly cautious and want to do everything I can to try to have this baby naturally. I have read that Evening Primrose Oil will help to ripen the cervix without any side effects. Could you please give me any insight you have on this subject. I want to make sure there is no increased risk of uterine rupture. If you have any other advice, I would greatly appreciate it.
Thanks,
Denyse
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Dr David
Moderator posted 02 February 2001 11:37 AM
Denyse
One could look at a series of issues:
Macrosomia (big baby) and VBAC
Flamm reported their experience with VBAC in women with large babies. They found lower VBAC rates, but no significant difference in perinatal or maternal morbidity when compared to VBAC with babies under 4000g, or with women with macrosomic babies but with no uterine scar.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2638575&dopt=Abstract
See also Canadian Society guidelines which suggest that macrosomia is not a contraindication to VBAC.
http://www.sogc.medical.org/SOGCnet/sogc_docs/common/guide/pdfs/ps68.pdf
Macrosomia and induction (not in VBAC)
Cochrane meta-analysis does not show benefit of induction over waiting.
http://www.cochrane.de/cochrane/revabstr/ab000938.htm
Induction with oxytocin in VBAC
In one study of 2774 women, VBAC labour induced with oxytocin had rupture rate 2.3% versus 0.4% in non-induced, non-augmented labour.
In another with 2119 attempted VBAC, rupture rate with induction not requiring cervical ripening (ARM +/-oxytocin) 0.74% versus spontaneous labour 0.45%, but this difference was not statistically significant.
This is not a complete literature review, but may be an aid in discussion with your obstetrician.
You need to decide what is the right course of action for your particular situation.
I have no published data on effectiveness or safety of EPO in VBAC induction.
Dr.David
DISCLAIMER:
This advice is of a general nature to help in decision-making. It
does not constitute recommended treatment for an individual. You must
consult your health care provider for individual
advice.