Why Misoprostol (Miso) Isn’t Used for VBAC Induction
She showed up for her scheduled induction, bag packed, heart full of hope for her VBAC. After all the home birth preparation, the heartbreak at not being able to do the homebirth because of the location of her placenta, the planning, and the excitement of finally meeting her baby, she was ready to get things started.
But when she arrived at the hospital, she was told: “We can’t use miso for your induction because you’ve had a previous C-section. I wish they had told you that before!”
It was confusing—especially in the middle of a big, emotional moment. Why hadn’t anyone told her? (spoiler: I can’t answer that one… it’s my perpetual question inside the Beyond Birth Blueprint and the actual reason it was born) Isn’t miso supposed to be gentler than starting right in with pitocin?
Let’s break it down.
What is misoprostol?
Misoprostol (nicknamed miso, no, not the soup) is a medication that helps get labor going. It works by ripening the cervix—softening it and helping it open—while also stimulating contractions.
It’s often used when someone needs an induction but their cervix isn’t yet dilated or effaced. Miso is usually taken as a pill by mouth or it can be placed in the vagina in very small doses.
Why can’t miso be used after a C-section?
Here’s the key issue:
A previous cesarean leaves a scar on the uterus.
Miso can cause very strong contractions.
Strong contractions put more stress on that scar, and studies show miso increases the risk of uterine rupture (when the scar opens during labor which can be life threatening to all parties).
Uterine rupture is rare—but when it does happen, it is an emergency for both parent and baby. Because of this, miso isn’t considered safe for people with a prior C-section scar.
What are the alternatives for VBAC induction?
If you’re planning a VBAC and need an induction, there are safer options that your provider might use instead:
Foley balloon or Cook catheter → a small balloon placed in the cervix to gently open it.
Oxytocin (Pitocin) → an IV medication that stimulates contractions in a more controlled way.
Membrane sweep → a simple office or hospital procedure that releases your body’s own prostaglandins.
Breaking the water (amniotomy) → used when the cervix is already pretty open and ripe. (the word ripe for a body part… I’m just not sure!)
The bottom line
If you’ve had a C-section before, you might hear: “No miso with a scarred uterus.” That’s not because your body isn’t capable of labor—it’s because miso specifically raises the risk of rupture more than other options.
For VBAC parents, knowing this in advance can help you feel less blindsided if induction is recommended but you aren’t offered the typical course for an induction. You can walk into your birth informed, prepared, and confident about the safer alternatives available.
At Be Well Baby, we believe every parent deserves to understand not just the what, but the why—so you can meet your baby feeling supported and empowered.
💡 Want more VBAC-friendly tools and tips? Our online learning platform: The Beyond Birth Blueprint is here for you every step of the way.
