seek success stories: VBac w/ single layer closure

[smallbutfeisty]

Turns out I have a single layer closure. My midwife says this increases risk of rupture from 1% to 2%, which is not a big deal. It just causes me a little pause, though.

I will have a hospital birth & ob will be avail should anything go wrong (this is law in NJ). The midwifery practice I am using claims a 95% success rate with VBAC, and is very supportive.

So, anyone have success stories to share with me to ease my mind? Or any thoughts at all?
Thanks so much!

[alternamama82]

I have a single layer too, and am planning a VBAC for this April - Not quite 13 months after my c-section. My doctor never batted an eye at the prospect either, and in fact is very encouraging of it.

I've read alot of mixed info about the double layer sutures. Some studies show that they are not beneficial and actually cause more scar tissue to form, in turn making the scar weaker and more likely to rupture. A thicker scar does not necessarily mean a stronger one.

[kathan12904]

Two things about the op have me raging and not at the poster. First of all, all the scientific studies point to absolutely no difference in rupture rates, meaning some studies say its increased with single layer and some say its increased with double layer. Secondly, the rate of uterine rupture for vbacers is somewhere between .2 and .5%, nowhere near a whole 1% and it most certainly doesn't double based on your scar type. Even the studies that show an increase in rupture with a single layer closure don't show it doubling. Double layers are considered a stronger seal, but they don't stretch as much. I hbaced my son with no problems after a single layer suture. I hate the misinformation out there about this and I also hate that Ina May keeps supporting the idea that single layer sutures are "a ticking timebomb" Good luck with your vbac and don't let your layering concern you. Its much more important that you had an infection free recovery from your original surgery than what layers you had.

[liberal_chick]

Originally Posted by kathan12904

Two things about the op have me raging and not at the poster. First of all, all the scientific studies point to absolutely no difference in rupture rates, meaning some studies say its increased with single layer and some say its increased with double layer. Secondly, the rate of uterine rupture for vbacers is somewhere between .2 and .5%, nowhere near a whole 1% and it most certainly doesn't double based on your scar type. Even the studies that show an increase in rupture with a single layer closure don't show it doubling. Double layers are considered a stronger seal, but they don't stretch as much. I hbaced my son with no problems after a single layer suture. I hate the misinformation out there about this and I also hate that Ina May keeps supporting the idea that single layer sutures are "a ticking timebomb" Good luck with your vbac and don't let your layering concern you. Its much more important that you had an infection free recovery from your original surgery than what layers you had.

This.

I had a successful HBAC 10.5 months ago, no problems with my single layer closure.

I had several MWs refuse to attend me "under the table" (AR law prohibits MWs attending HBACs, but many will do it anyway b/c they don't agree with the law) due to the fact that I had a single layer closure. But I could never find any real, definitive information saying a single layer was worse.

I even asked my OB (with whom I had concurrent care) if he'd sew me back up with a double layer closure in the event I had another c-section. He told me that when you create a double layered scar, you are folding in part of the uterus that wasn't in that area to begin with, if that makes sense. He would be sewing the original cut, and then folding in more of the uterus (a part that wasn't cut) to sew together as well.

I have no idea if I described that well. I'm having trouble articulating what exactly I mean.

[dlm194]

First of all, the risk of uterine rupture without the use of induction agents or pitocin is 0.4%. For the most part, this should be your situation with VBAC supportive midwives. The claim that your risk increases to 2% is debatable, at best. Under certain circumstances, I could get on board with that but more likely than not, your risk is similar to a women with a double layer suture. The key criticisms of the 2 studies that show an increased risk of UR with single layer sutures are the fact that most of the women were induced or had pitocin, most women were sutured with a material called chromic catgut which is weaker than the material more commonly used these days (Vicryl and Monocryl) and the studies were done at 1 hospital where they did a lot more double layer sutures (surgeon technique and skill comes into play here).

I labored for 41 straight hours on a single layer suture. You can read my birth story here. (I'm hoping it's not "my" midwives that quoted you that risk. I'd have to mention that to them. They know I can quote this stuff in my sleep!!! )

Just an fyi.... here is a link to summaries and criticisms of suture studies:
studies favoring double layer sutures
studies showing no difference between single and double layer sutures

[smallbutfeisty]

dlm, yup, your midwives--I'm sorry I haven't followed up, but did make the same choice to go to them. I think the drive to see them is going to kill me, but after a first appointment am already very happy.

Thank you, everyone, for your feedback. Clearly, I'm not as educated on all the studies and information out there, so I'm glad you can help me.

[dlm194]

Uh oh!! I gotta go talk to them.

In all seriousness, check your surgical report (or if you gave it to them, just ask) to see what your c-section suture material was made of. It will say something like 0 Chromic or 1 Vicryl, etc. If it's chromic, you may have a slightly higher risk but it means you need to avoid induction or pitocin use as much as possible (which shouldn't be an issue with them anyway). If you have vicryl, then there is absolutely no reason to believe that your risk is in anyway elevated vs a double layer suture. And you can tell them crazy VBAC Dana said that. Their old back up doctor used to require single layer suture VBACs to have an IV in. During my visit with him, I went over the studies and explained why I disagreed with calling me a higher risk. I told P&L I was going to do that ahead of time so when I was talking to him, Louise walked in with my chart and winked at me on her way out. He was really nice about it though and didn't say anything about an IV so I just had a saline lock in place. After my big conversation, he still quoted my risk as 1%.

Bottom line is that you don't even need to worry anyway. They are super patient and if they have any concerns about an increase risk of UR with a single layer suture, you won't see it in them during your labor. I know of at least 3 women who VBACed with them on single layer sutures. My labor kept stalling so I used nipple stim to keep the contractions going. One of my friends (who is on here as well) opted to use a little pitocin since her water had been broken well beyond 24 hours and they kept it a very low dose (as opposed to many providers who will increase the pit dose every 20 minutes).

[thepeach80]

I've had 3 VBACs w/ a single layer suture, the last 2 included the use of pitocin.

[HappyMommy2]

I had an awesome HBAC with a single suture.

Good luck mama!

[kltroy]

The data haven't really borne out the notion that a double-layer is much better than a single layer.

FWIW, I had a VBAC w/ a single-layer suture 18 months ago and everything was great (birth story here). I had even told the doctor who did my c/s that I wanted a VBAC with my next pregnancy, and to "sew me up good" and he *still* did a single-layer. I think the Ina May book, while otherwise wonderful, did us VBACers a disservice by scaring us into thinking we *had* to have a double layer suture. The evidence just isn't conclusive.