Give me your take on this study

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momW's picture
Joined: 09/29/09
Posts: 5634
Give me your take on this study

Slowed Dilation May Warn of Rupture

(VBAC study)

My take on it is two part. It makes me nervous that OB's could see this like they do a couple of bad reads on baby's heart rate with the EFM and jump to cut too soon. I hope that it will make more OB's aware that inducing and augmenting VBAC's carries more risks than just hyper-stimulating a scarred uterus that it can actually override the bodies ability to warn of problems (ie slow dilation).

I just read it for the first time though so I'm wondering what everyone else thinks after reading it.

boilermaker's picture
Joined: 08/21/02
Posts: 1984

Seems like a pretty useless study that only affirms what we already knew. Augmenting a VBAC carries additional rupture risk, albeit a REALLY small risk.

And not nearly as risky as a repeat c.

So slowed dilation MAY warn of rupture or it MAY NOT......useless IMO.

alwayssmile's picture
Joined: 08/26/07
Posts: 14483

*lurker*

I don't feel like I learned anything.

However, those who ruptured were more likely to have labor induced and to have received oxytocin.

That was the key statement that made me laugh and immediately ignore the rest. I already know that if I want to have a successful VBAC in the future, I cannot induce. Aren't rupture rates supposed to be higher for those who are induced and use artificial means to speed along labor?

And I agree Christa that if OBs see this, some are going to think that a slow labor (which I already have issues with because women don't all progress the same naturally) means greater chances to rupture, leading to augmenting labor (yay let's up those risks! :roll:) or going straight to cutting. Yes, more paranoid OBs is exactly what the VBAC community needs. :banghead:

Spacers's picture
Joined: 12/29/03
Posts: 4103

I don't have the time to look at it until Thursday, but I'm curious to see if it addresses this: If slowed dilation results in augmentation, then obviously the rate of rupture is going to increase, but does the slowed dilation *itself* indicate that rupture would be more likely, if the mom was left alone? If they haven't filtered the data for that, then I'm not sure I buy anything they're selling.

jolly11sd's picture
Joined: 02/02/05
Posts: 3327

I'm not sure I buy what they are selling either. Its doesn't really seem to say if what spacers pointed out is happening. Are the slow dilation ladies being augmented with things that could lead to rupture? I can't see that slow dialation alone (without augmentation) would be a good argument for a woman rupturing. Heck, personal experience, I dilated very slowly during my VBAC even after hitting 7 and didn't rupture. But that was just me.

momW's picture
Joined: 09/29/09
Posts: 5634

Yeah, it seemed very DUH to me as well. I would REALLY like to see a study that comes out and says flat out without question that augmenting labor for a VBAC patient is dangerous. I had a really good friend rupture during her VBA2C. Our OB is against induction for VBAC's but not augmenting slowly. I was firmly against pitocin during my VBA2C because my thought was if my body couldn't get there on its own, there was a reason. There are many, many OB's out there that will augment a VBAC labor and I think that is really dangerous as in the case of my friend who was augmented because of "stalled" progress. I have no idea if the pitocin leads to a rupture during augmentation or if it just forces the body to keep dilating even though it's in the process of rupturing but either way I think many problems could be avoided. I was really hopeful when I started reading this one that it would point to what I mention above, a clear and indisputable NO augmenting VBAC labors, but it didn't and that disappointed me.

Spacers's picture
Joined: 12/29/03
Posts: 4103

"momW" wrote:

I would REALLY like to see a study that comes out and says flat out without question that augmenting labor for a VBAC patient is dangerous.

It's not going to happen, because it's not necessarily true. There have been at least two studies recently that showed augmenting VBAC labor is safe when it is done in a prudent manner. The problem is that most hospitals do not have a separate VBAC protocol, so when Pitocin is used in a VBAC, it's done in the same manner as inducing labor on an unscarred uterus. That fact is skewing all VBAC statistics, and it's likely leading to more RCS out of fear of rupture that has simply not been shown to be happening when the VBAC protocol is followed.

Having now read that article, it's no different than any other article about uterine rupture. Augmented labors were not separated from unaugmented labors, and it doesn't state whether those who were augmented were under the VBAC protocol or got the standard Pitocin regimen. Bleh, nothing new, nothing alarming, same old, same old...

AnnaRO's picture
Joined: 07/06/08
Posts: 7033

"alwayssmile" wrote:

Aren't rupture rates supposed to be higher for those who are induced and use artificial means to speed along labor?

Yes. Though as Spacers mentioned, if proper protocol for VBAC is followed it can be done safely. My OB will not induce and is against any methods to induce or encourage progression of labor. When I presented my birth plan, he said that it was ideal because I'm a VBAC and he feels that anything, including AROM or sweeping, could potentially increase my risks and he would rather allow my body to just do it's own, natural thing. Which I am grateful for because it works so well with what I want.

krazykat's picture
Joined: 08/11/07
Posts: 1143

"Spacers" wrote:

It's not going to happen, because it's not necessarily true. There have been at least two studies recently that showed augmenting VBAC labor is safe when it is done in a prudent manner. The problem is that most hospitals do not have a separate VBAC protocol, so when Pitocin is used in a VBAC, it's done in the same manner as inducing labor on an unscarred uterus. That fact is skewing all VBAC statistics, and it's likely leading to more RCS out of fear of rupture that has simply not been shown to be happening when the VBAC protocol is followed.

Having now read that article, it's no different than any other article about uterine rupture. Augmented labors were not separated from unaugmented labors, and it doesn't state whether those who were augmented were under the VBAC protocol or got the standard Pitocin regimen. Bleh, nothing new, nothing alarming, same old, same old...

This! Studies have shown that slow pitocin induction for a VBAC (especially with a ripe cervix) does not significantly increase risk. It's the prostaglandin inductions (i.e. cytotec and cervidil) that are the most dangerous. You can stop pitocin, which has an incredibly short half-life, but you can't stop a prostaglandin induction once it is applied to the cervix.

I labored for 48 hours at home with DS and never had any concern of rupture. But that is also an individual case.

momW's picture
Joined: 09/29/09
Posts: 5634

Spacers- Do you have links to the studies you are referring to? I'd love to add them to my stash of stuff Smile

alwayssmile's picture
Joined: 08/26/07
Posts: 14483

"momW" wrote:

Spacers- Do you have links to the studies you are referring to? I'd love to add them to my stash of stuff Smile

DITTO. Smile

Anna, really glad to hear that!!!

krazykat's picture
Joined: 08/11/07
Posts: 1143
Starryblue702's picture
Joined: 04/06/11
Posts: 5454

"boilermaker" wrote:

Seems like a pretty useless study that only affirms what we already knew. Augmenting a VBAC carries additional rupture risk, albeit a REALLY small risk.

And not nearly as risky as a repeat c.

So slowed dilation MAY warn of rupture or it MAY NOT......useless IMO.

This. The entire article actually confused me... a lot lol...

Spacers's picture
Joined: 12/29/03
Posts: 4103

"krazykat" wrote:

Here are two:

Higher maximum doses of oxytocin are associated with an unacceptably high risk for uterine rupture in patients attempting vaginal birth after cesarean delivery

Does a maximum dose of oxytocin affect risk for uterine rupture in candidates for vaginal birth after cesarean delivery?

Thanks! I was offline over the long weekend. Smile I sent my OB an email last week asking for information about the two studies she told me about when I was pregnant with Weston. She had recently been involved in peer review on both of them, and it was because of those studies that my HMO had revised their VBAC guidelines to include an acceptable Pitocin augmentation protocol. I'm not sure if these are the same studies or not, looking at the dates they *could* be but I'm not sure.