2 Things you Might not Know about Induction & VBAC
There’s a lot of misinformation about the safety of induction for a VBAC. You’ll hear people say that induction should never be used during a VBAC. You’ll even find obstetricians and midwives who have a blanket policy of not inducing for VBACs. On the other hand, you’ll also find providers who are quick to induce. And the may make claims that it is less safe to attempt a VBAC once a pregnancy passes the 40 week mark. In truth, none of these claims are entirely true. Furthermore, the issue isn’t as black and white as some make it seem.
2 Important Things you Might not Know about Induction and VBAC
1. Induction of labor is an option for people attempting a VBAC.
ACOG (American College of Obstetricians and Gynecologists) states that, “Induction of labor remains an option for women undergoing TOLAC (trial of labor after cesarean).” (ACOG PB No. 184)
2. Studies have found that the risk of uterine rupture does increase with an induction.
Landon, et. al (2004) found that induced VBAC labors had a uterine rupture rate of 1.0% while spontaneous labors (labor that began on its own) had a uterine rupture rate of 0.4%. And Palatnik and Grobman (2015) conducted a study that saw the elective induction group have a uterine rupture rate of 1.4% and the spontaneous labor group have a uterine rupture rate of 0.4% – 0.6%.
It’s interesting to note that the 2015 study also found elective induction at 39 weeks to have a higher chance of VBAC.
What does this mean for you?
Because induction does carry some increased risk, it’s important to determine if your proposed induction is medically necessary when you’re planning a VBAC. Medical indications for an induction include, but are not limited to maternal health complications, fetal health complications, going past 42 weeks, placental abruption, preeclampsia. Going past 40 weeks without any other complicating factors is not, in and of itself, a medical indication for induction.
“Because induction does carry some increased risk, it’s important to determine if your proposed induction is medically necessary when you’re planning a VBAC.”
Unfortunately, there is no simple and clear choice that can be applied to all people when it comes to induction and VBAC. Your preferences, goals, and birth history should all factor into your decision. For some, an induction could be the option that ultimately avoids a repeat cesarean. For others, it could lead to further complications and the risk wouldn’t be worth it. Only you, in close consultation with your support team, can decide the best course of action for your birth.
How can you decide whether or not to have an induction for your VBAC?
Many people who have had a primary cesarean have gone past their due dates and experienced an induction that led to the cesarean. I understand that your previous experience might add an extra layer of fear and anxiety with you are faced with a looming induction for your VBAC. If your provider is suggesting an induction for your VBAC, here are some things you can do to help you decide whether or not to be induced.
1. Communicate with your provider.
Ask your potential provider early in your pregnancy about their philosophy on induction and VBAC. Find a provider who supports your goals. (Grab my free guide to help you find your best provider). When your due dates gets closer, ask as many questions as you need to fully understand your options. Additionally, ask your provider to clearly explain the risks and benefits of each option. It’s OK to ask for research to support their answers if you need to. Here are some questions you might ask: “What are the benefits of inducing now? What are the risks associated with this induction? Are there any alternatives? What if we wait for labor to start and revisit this in X days?”
2. Don’t rush your decision.
Understand that every birth decision comes with potential risks and benefits. Learn about and discuss the potential risks and benefits of each of your options with your provider and your support team. As you lay out pros and cons, you will likely start to get a clearer idea of which set of risks and benefits feels most comfortable for you.
3. Trust yourself.
This can be the hardest one. Know that you will make the very best decisions you can in each new moment and with each new piece of information you receive. Learn, communicate, and decide what you want to do. Because there is no crystal ball when it comes to birth outcomes, we need to accept that we can only continue to make the best decisions possible with the tools and information available. The best way to increase your chances at having an empowered birth are to be sure that you remain the decision-maker during your journey. You do this by continuing to ask questions, gathering information, and choosing what feels best to you.
If you’re facing a difficult decision about induction and your VBAC, come join my closed Facebook group and let us support you as you navigate this situation.
I'm Taylor, your VBAC Doula
I’m a doula, doula trainer, childbirth educator, ICAN leader, cesarean mama, VBAC mama, and HBAC mama. My mission is to support VBAC hopefuls to have empowered births.
"Taylor is warm, encouraging, and assertive. She allowed me to take charge and supported my decisions. I know that is the role of a doula, but I guess I expected to be following her lead or waiting for her suggestions. In the moment of labor, I needed those around me to support me in whatever felt right in that moment. It’s like she knew my body would lead and she followed that. I felt loved and heard every step along the way."