Although it’s ideal for labor to start on its own, moms wanting to TOLAC can be safely induced and have a VBAC.
According to ACOG, a prior low transverse C-section is not a contraindication to induction (other than the use of Misoprostol/Cytotec), so a Foley catheter or low dose Pitocin may be used safely in most women.
The problem arises when a practitioner does not believe in doing inductions on women with a prior C-section.
What are Some Gentle Ways to Induce a Mom Wanting to TOLAC?
Natural Induction Methods
- Stripping of membranes: This is typically performed in the office of your provider. Your medical provider inserts their finger into your cervix and separates (sweeps/strips) the amniotic sac from your uterine wall. This can release prostaglandins and stimulate labor contractions.
- Evening Primrose Oil: Oil from the seed of the evening primrose plant. When due dates are coming up and induction looks like it may be necessary, many moms and midwives will look into Evening Primrose Oil (EPO). The idea is using it vaginally or orally to soften and ripen the cervix to prepare it for labor. We do NOT recommend taking this during pregnancy. There are only two studies available on its safety and effectiveness. Neither study showed that it helped progression of labor and one of those studies, referenced below, defines it as not supported during pregnancy and it should be avoided. It is linked to bleeding issues, rupture, and complications during Cesareans.
- Foley Bulb Induction: A small catheter is inserted into the cervix, where one side of the catheter is deflated. Once your provider inserts it into the cervix, they will then inflate the balloon with saline. This causes pressure on your cervix and will encourage your cervix to dilate. You must be dilated a little (1cm) to insert the Foley.
Other Induction methods
- Pitocin: A synthetic version of Oxytocin. Oxytocin is the hormone that your body naturally produces to induce contractions, as well as serving as the famous “love” hormone. Pitocin is administered via IV. Starting it low and increasing it slowly is a great way to gently encourage labor to start on its own.
- Breaking Your Water: The amniotic sac lines the uterus and houses the amniotic fluid, baby, and placenta. It provides a barrier to infection for your baby during pregnancy and cushions the baby as you move.
- Cytotec/Cervidil: As stated previously, the use of Misoprostol for a VBAC is NOT safe. In a case control study of 512 women attempting VBAC, 5.6% of women receiving Misoprostol had symptomatic uterine rupture compared to 0.2% of women having a trial of labor without Misoprostol. DO NOT USE Misoprostol for VBAC induction Sometimes there are TRUE medical reasons why a mother would need to be induced. We talk more about that on one of our earlier blogs HERE.
Gentle Induction for VBAC:
If VBAC induction becomes necessary for whatever reason at whatever gestation, discuss with your provider what options are available to you and start with the lowest, slowest option possible.
We have seen amazing success with the following method:
- Ask for an outpatient Foley Bulb. This is where they insert the Foley bulb and then send you home with instructions to come back in when it falls out.
- After the Foley Bulb falls out and you get back to the hospital, if contractions haven’t started yet, request to start Pitocin slowly and on a low dose. Starting at a 0.5 or 1 unit and upping it by that many every 45 minutes is a great gentle nudge to let your body know that it is time.
- Once your body has been in a regular contraction pattern and you are in active labor, ask for Pitocin to be turned down or even completely off. Often, once Pitocin has gotten things started, they keep going without that additional stimulation.
Find a VBAC Supportive Provider
When you’re looking for a provider who is truly supportive, we suggest asking them their views on induction and TOLAC/VBAC.
Ask what inducing a VBAC looks like to them, what method is their chosen way to induce, and how they feel about it. Although it’s better to go into labor spontaneously and many women do so after the 40-week mark, it’s best to know your provider’s view in the beginning so you are prepared to handle circumstances that may come up.
Check out this week’s podcast episode all about Kimberly who rocked an induced VBAC!
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