need advice about VBA2C with a previous dehiscence.

[mamamccloud]

I have hated my power and freedom taken away from me by C-section and I want to VBA2C if possible. I wanted to get some real advice from moms or professionals out there who have had some experience or have some real advice regarding my situation. I have a 2.65 year old a 14 month old and am 31.5 weeks pregnant. I had C-sections with my first two and found out I was pregnant much sooner than I expected/planned. I had a c-section with my first as a result of a short umbilical cord and fetal distress. With my second I tried to VBAC, but never went into labor since I had a lot of amniotic fluid, she never even thought about engaging and instead was head down, but at an angle. Durring the c-section my doctor found out that I had a "dehiscence" or as she put it in the post-op report "a 5 x 2.5 rupture in the myometrium". A specialist corrected her and used the word "window". My doctor with the utmost care and also freeking out, repaired my wound I can't remember how she described that, but I know she was meticulous. I don't know when I got the window/dehiscence, but I do know that the day that I had the c-section I tripped on the way into the hospital and though I didn't fall down, I jarred my pelvic/lower abdomen area sharply and was in a lot of pain. I had sharp, localized pain for a while and was definitely sore until I was prepared for surgery. I think I could have done it at that time.
So now I am with 6.5 weeks until my scheduled c-section wondering if I really have to have a c-section. I have met with a midwife who is contemplating delivering me, and I am constantly searching for information regarding my particular situation. After reading some of the mom's stories here regarding there dehiscence and then a serious uterine rupture with their next pregnancy, I am seeing that there may be more to this dehiscence thing than just a regular VBA2C. Finding research on this topic has been extremely difficult.
I would love some information or someone to share their experience with me, since there is very little research out there regarding my situation. I want to be safe, but I don't want paranoid. I want a VBA2C if I can have it. If the risks are too great, I will feel much better and much more surrendered to a RCS. I just want to be informed and have the power to make the best decision for myself and baby.
Thanks for your help.

[channelofpeace]

I not a midwife, but I am a not-currently-practicing doula and a vba2c mama. I will share my thoughts on your situation and you can do with them what you will.

I will first of all say that I am very very (obviously) vbac supportive and think that for most women it can be a safe and healthy experience. A couple things about your situation would give me pause though.

First, the spacing between your last c-section and your upcoming birth is of concern. Optimally, there should be at least 18-24 months between the time of your c-section and your vbac attempt. This is to allow the uterus enough time to heal before growing/birthing another baby. This alone wouldn't be a deciding factor, but given your other history, it is something to take into account.

Secondly, and what I think is of most concern, is that you had a dehiscence without labor. There was a window even without the stress of labor and so I would be concerned that there might be some issues with scar integrity during labor since the uterus obviously is a lot more dynamic then. These two factors combined constitute more risk than I personally would be willing to take.

I am sorry that you are faced with this decision, my older two were 3 1/2 and almost 2 when I had my vba2c and it would have been difficult to take care of them while recovering from a c-section. I imagine you are feeling very torn about it. Like I said, I am not a health professional, but since I have had a couple c-section and gone on to vbac, I can speak from that perspective.

Take care in whatever you decide. If you do opt for the c-section, there is a natural family living c-section thread in birth and beyond that may be of help to you.

[Devaskyla]

From what I've read, a lot of windows seem to be caused by the way the woman was sewn/healed from the previous cesarean and have nothing to do with scar integrity. In fact, I know there have been studies that show dehesiences don't increase the risk of rupture. 'Benign' dehesience was how it was referred to.

If it was a result of the way you healed from the previous cesarean & your doctor at the second one was meticulous in how she sewed you up, you shouldn't have it anymore and it shouldn't be a problem. If it was from something else, it might be of concern or it might not since, again, it was sewn up & should have healed as well as the rest of your incision.

Did you have any ultraounds during your last pregnancy? I wonder if they looked at the scar area at all.

[mamamccloud]

Next steps

Thank you both for your input. I feel so confused now as to what I need to do. I was planning for a HBA2C up until the night I found the other moms in the birth and beyond forum that had some negative dehiscence experience. So, I think that I'm going to have to call and cancel with my midwife. I'm feeling that if I find some reassuring information regarding successful VBAC in my situation I should VBAC in the hospital. So I'm thinking that I should stay with my MD.

So much of me wants to just numb out and and not make any decisions as I try to sort through all of the research. But I know that I will regret that. Do any of you know where I might find information regarding the impact of a previous dehiscence on a subsequent pregnancy?

The next steps I'm planning to take are to talk to my OB about my uterus. And I also feel that I would benefit from having an ultrasound to see how thick my uterus is in that location. I've found studies that say that if the thickness is greater than 1.8 mm than chances of UR are not likely. I've also found studies that state that women with myomectomies have a considerably higher rate of uterine rupture after their surgery several cases of women rupturing at 33 weeks. I am not certain how that relates to me, but I'm having a difficult time trying to figure out how any of the information relates to me.

After reading all of this confusing and litterally morbid research, I am leaning towards having my scheduled c-section.

[Amylcd]

I had a dehiscence with my second pregnancy - decided to have a vba2c with my third and had a rupture. Everyone is different so it does not mean that you will have a rupture, but it does happen.

[mamamccloud]

Better News

I had my appointment with my doctor yesterday. I dropped a letter off to her the day before the appointment, letting her know my thoughts and desire for a VBA2C. I also included about 8 questions that I wanted to discuss with her at my appointment today. But she came into the room and confessed that she hadn't yet read my letter so she proceded to read it. she was visibly shaken up, but as she finished my letter she said that she would help me with the literature search and that she thought that getting an ultrasound to see if they can tell the thickness of my uterus was a really good idea.

She then went down and answered my questions from 1 - 8. She said that:

she used my dehiscence to open the uterus so there is like one larger scar as opposed to opening the last scar.

she closed it with a double layer.

my dehiscence was fresh, had raw edges, and was recent, so it really may have happened when I tripped and hurt myself.

My uterus was thinner at 42 weeks, but was not outside the normal range and "I've seen women with uteruses as thin as yours and not rutpure".

She regretted and took personal blame for letting me go so long especially since my uterus was so distended (my daughter was 8lbs 10oz, but my AFI was 21). Though I assured her that she did everything right, and as a result we were both healthy.

So I have an ultra sound, 2/24 I will be 34 weeks. And I plan to have one when I am near the end of my 37th week. I am so impressed that my OB was able to overcome her trauma and really has an open mind. She confessed after all of that, that she was really fightened when she saw my dehiscence and was very shaken up by it.

I feel really good about the results and have a really good feeling that I am going to be able to make the right decision and have the support of my OB. I feel like the obstacles are being removed one by one so that I can focus on birthing my baby. I'm so happy that my uterus was not just weak. But it had an issue and was stitched up properly, but overall was in great condition. Now I just have to get the best understanding that I can about how it healed. Granted that I and my OB feel alot of trust in my uterus, I'm going to have a VBA2C.

[KaylaBeanie]

I just wanted to wish you luck! Human bodies are incredibly resilient.

However, I noticed your planned section was at 38 weeks. Should you decide against the VBA2C, you really should talk with your OB about pushing it back. There was recently a lot of coverage on the news about the problems that come with scheduling sections at 38 weeks.

[mamamccloud]

after u/s appt. also posted in VBAC forum

I had my appointment yesterday. I found out the following:

My Placenta is anterior and ends about 3-4 inches above my previous scar - so if I did have a rupture it has a high probability of adversely affecting my placenta and its attachment.

My uterus measures about 1.5mm about an inch above my cervix and 1 mm a bit above that. I'm not sure how accurate the ultrasound is, but I was able to see the muscle wall in the location that had 1.5mm and it was nearly invisible at the 1mm location and the dr. said that I could already have a window in that spot. Since he could not really measure the myometrium at the place where it was 1 mm, he also measured all of the layers in that area from the myometrium and the bladder wall and all of that measured 3mm. I know that studies show that at 3 mm the measurements are way more accurate. I can't say for sure what all of the numbers really mean based upon accuracy. But I did see the different layers with my own eyes and it was not encouraging. Studies I have been reading that correlate rupture and uterine thickness show a higher percentage of rupture (like 18%) for women who have a measurement by u/s of 1.6 or less.

He did say that statistically, I could very well have a successful vbac, but if he were to say if he was to guess if I was a good candidate he would say no.

Thanks to my research and the support and information provided by all of you online community mamas I was really able to get all of my questions answered. I think that he was prepared to intimidate me, but when he saw that I was really interested in the facts, he gave them patiently as I asked. I really saw a turn in the appt. as a result of being educated and being treated like an educated adult and not a new victim to be intimidated. He was not really interested in the beginning about trying to get a good read on my scar and began to make excuses as to why we can't see it, but after he saw how important it was to me and how it was the major factor at this point in my decision, he worked really hard to get the baby out of the way so there were no shadows. He showed me internally and externally where he the thin parts were, so that I would have security that he measured the right place. I know that he was still biased, but I know that the numbers that he received were the actual numbers and felt that I had enough understanding to interpret them for myself. I was able to see everything for my self.

My AFI is 22, so I was disappointed that I am still carrying so much fluid since it will also contribute to stretching out my uterus. He assured me that it was inconsequential and normal, but I know how it has affected my uterus and labors in the past.

So, after asking all of my questions and thanking him for spending all of that time with me (I know they are not in the habit of spending alot of time with patients), I got dressed, went outside and cried with my mom and husband. I knew that my uterus was thin, but I had hoped that it would be at least 2 mm. Considering the window that I had last time, I knew that I could not afford to take the risk of VBAC if my scar measured less than 2mm.

I still feel kind of frustrated, because I feel like if there are women that VBAC after a dehiscence why can't I. What is the difference between them and me? Then there are equal numbers of women who vbac after a dehiscence and have catastrophic ruptures and I think why does that have to be me? Can't I be different than them? But I think that I am not. I think that all of my research has pointed out that I am more similar to the women with catastrophic ruptrues who have gone before me - and to whom I feel very grateful that they shared their stories and made me look into and research my body and the information very deeply.

The baby was beautiful and looks just like my husband. I want this baby and I'm not willing to risk his life with the same math mathmatical chance as russian rullet. I am going to schedule my c-section today at my appt with my ob. This journey has led me to understand that I can have my c-section be as much like a birth as possible. I want to see my baby with all of the blood and vernix. I want to see my placenta. I want to cut it when I am recovered. I want to see my baby come out of me this time. I want my baby skin to skin in my arms as mine this time - I don't want my baby given to me wrapped in a blanket - I want it in all of its new born glory.

I do secretly hope though that I miraculously dilate to 8 cm without know it and go to the hospital with my baby crowing and push him/her out. So please send those vibes my way. I'll be in touch. Thanks for everything. Feel free to give your two cents, even if you disagree with my decision. I am really grateful to all of you and I am excited because - I'm going to have a baby!

[mamato3cherubs]

I dont have any experience or expertise to reply, just wanted to thank you for updating, and hope you will as your experience happens and you bring this wonder into the world.

Sending easy dialation vibes your way

[FlipMom23]

I know this is an old post, but I'm faced with almost the same situation.   I've had three c-sections, with the first being an unplanned c/s after 30+ hrs of back labor, the second a scheduled c/s (I didn't know any better at the time), and my last being an attempted VBA2C that ended in c/s after her hr dropped with every contraction into the 30s.  Once I was opened up, the doc said that the scar was so thin that he could see the baby right through it.  He said he had to cut out a lot of scarred/damaged tissue and had to pull pretty tight to get it stitched closed.

So here I am, pregnant with #4 and wondering about VBAC.  Pretty sure I know I'm stuck with a c/s again.  I'd also love to hear how the OP's experience turned out.

[kltroy]

Here's the follow-up post from the Orig. poster - sounds like she had a very nice c-section (decided to schedule)

http://www.mothering.com/community/forum/thread/1051959/anybody-having-to-plan-a-c-section/40#post_13465935

[FlipMom23]

Thanks for the link!  Sounds like she had a great birth.  I can only hope mine goes that well.

[goingon7]

hi, everyone.

i started when i was really young. at 16 years old, i had my first baby on 2/24/1997 through c-section, because my son was breech. after a year i had my 2nd baby, vbac.  everything went well. i was able to have a total of 6 vaginal deliveries after my first c-section. then with my 7 pregnancy, i had a 2nd c-section, due to irregular heart beat, it turned out that my son had the cord wrapped around his mouth.  i was lucky. this time i'm pregnant again this will be my 8th pregnancy.  i really wanted to try vbac2 because i have had 6 successful vaginal deliveries after my first c-section.  my ob does not agree.  but thanks to a lot of moms whom had experience vbac2, it sounds like they were successful.  i'm currently trying to seek another Ob's opinion.  i really feel that i can have a successful vbac2, but is scared for the baby and my wellness.

so to moms who is thinking about vbac after first c-section.  i do recommend to look into to see if you are a good candidate.  cause i was able to do it the first time, but am not sure about this vbac2.