Prostaglandin Gel

My first baby (8 pounds, 6 ounces) was induced 11 days past the due date, and was delivered by cesarean section. I'm expecting my second baby, and my midwife said she doesn't want the baby to get "too big." If my cervix is not dilating yet, she wants to start gelling it soon. She knows I really want to avoid a pitocin induction, so she said she'd gel me, monitor me for an hour and send me home a couple of times. How good do you think my chances are of going into labor with just the gel? Will inducing me with pitocin increase my chances of a surgical delivery?

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

I agree with you, and I think you are smart for considering the risks with intervention. Although prostaglandin gel will not generally induce labor unless the baby is ready, it does serve to ripen the cervix. If your first baby was eight pounds-plus at 41 1/2 weeks, it is true that this baby may be slightly larger; however, this does not mean that the birth will be more difficult or that another cesarean will be required. This baby could be smaller, could be in a different position or the uterine contractions could be more effective. If your section was due to failure to progress, it may have been due to a reason that may not repeat itself. If your pelvis is small, then gels may be a reasonable idea, but certainly not before your due date (in my opinion).

Your concern about one intervention leading to another is well placed. If all is well with you and the baby, I would avoid this intervention. You can have a non-stress test or contraction stress test/biophysical profile at 40 or 40-plus weeks and then start gels. Pitocin can be used with safety in women having vaginal birth after cesarean, so if this is necessary, try not to be alarmed.

I hope all goes well for you.
Peg

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