Did I have single stuture or double??

[claudi81]

OK since I am pregnant again I asked for my records to see what they put in and if I got single stuture or double layer stuture, now I read it and have no clue what that all means, what do you guys think???

Description of Procedure:

The uterine incision was closed with 0-Vicryl in a running lock fashion with good hemostasis. A second figure-of-eight was used in the midline to achieve hemostasis. The uterus was firm with P insfusion. There was normal pelvic anatomy.....etc...

Thats all they wrote as far as the uterus in adition that I had a low transverse cut. What does it mean now though single layer stuture or double layer?? Good or not good?


Besides of that they also wrote into my referal that I was induced with my first pregnancy with pictocin which caused hypercontractions, which was incorect I was induced with a prostaglandin gel a whigh amount of it that is why I had those crazy contraction with my first baby, which resulted in a c-section, I am crazy mad I am sure this is why I was not allowed to be induced with pitocin cause the report was wrong (

[HappyMommy2]

My c/s report didn't state whether it was single or double. I called the doctor, and the nurse said that the doctor always does single-layer sutures, and so that is most likely what I got. Just another two reasons to be mad! One, they don't even care enough to write it down, and two, they don't care enough to do a double.

I was freaking out. Read lots of posts on here about how it isn't really that big of a deal, even though Ina May says it is.

I went on to have a wonderful HBAC ... and am now planning my hba-hbac.

Good luck on your journey, mama! It feels pretty darn good to be on this side of it. Boy did I prove that my body is not broken, and I do not have CPD. :-)

[justKate]

I don't know what the report means, but I would call the provider and get a definitive answer. I don't think it necessarily risks you out, but it's good to know for sure what you're working with. As far as the induction discrepancy, what did your new provider say when you explained that the part about the pit was incorrect?

[TCMoulton]

Originally Posted by claudi81

Besides of that they also wrote into my referal that I was induced with my first pregnancy with pictocin which caused hypercontractions, which was incorect I was induced with a prostaglandin gel a whigh amount of it that is why I had those crazy contraction with my first baby, which resulted in a c-section, I am crazy mad I am sure this is why I was not allowed to be induced with pitocin cause the report was wrong (

I'm pretty sure that most Dr's will not induce a mom after she has had a C/S with pitocin regardless of your previous experience.

[claudi81]

yeah I fell pregnant just 7 months after my 2nd c-section, I just wanted to see if there is anything in my favor I will have a lot of convincing to do.

I do not know what they did cause my husband must have confused them when he keot on mentioning stitches stitches...no staples, he said they said something about double, but when I called the hospital and asked they said that they always do single

The part with the pit induction bothers me because I feel that they did not want to do it because the report said I was induced with pit the first time and it failed (which is not true it was a prostaglandin gel that caused the mess)
I was just wondering if I may have had my VBAC if they had giving me a bit of pit. They kept giving me the reason that bein 80% effaced and 1cm is not enough for pit I would have to be at least a 2 cm I was a sbit hasitated though cause who know what pit would have done and the c-section did go pretty well though!!

[HappyMommy2]

Originally Posted by TCMoulton

I'm pretty sure that most Dr's will not induce a mom after she has had a C/S with pitocin regardless of your previous experience.

This is not true. It should be!!! But it isn't. Even at the most natural-minded hospitals.

[HappyMommy2]

Originally Posted by claudi81

yeah I fell pregnant just 7 months after my 2nd c-section, I just wanted to see if there is anything in my favor I will have a lot of convincing to do.

I do not know what they did cause my husband must have confused them when he keot on mentioning stitches stitches...no staples, he said they said something about double, but when I called the hospital and asked they said that they always do single

The part with the pit induction bothers me because I feel that they did not want to do it because the report said I was induced with pit the first time and it failed (which is not true it was a prostaglandin gel that caused the mess)
I was just wondering if I may have had my VBAC if they had giving me a bit of pit. They kept giving me the reason that bein 80% effaced and 1cm is not enough for pit I would have to be at least a 2 cm I was a sbit hasitated though cause who know what pit would have done and the c-section did go pretty well though!!

Here are some things in your favor:

- Your strong will and determination.

- Your belief in your own body.

- Many mamas here have experience with VBA2C.

- Many mamas here have experience with VBACs even though there wasn't two years in between pg.

-Many mamas here have experience with VBAC after single layer suture.
---------------

Also - the single/double layer suture is on the insides. Totally different than the outside where they put the staples.

I understand the frustration of the bogus doctors reports. And then the double frustration of them just guessing at what happened when you call for clarification. It is appalling that they are so careless with the paperwork, and so blase about the procedures that seriously affect us mamas!!
------------

Regarding the pitocin and 2nd cs, you just never know what "could have been". All you can do is learn from the experience and do what will be safest for you and your baby in the future.

For me personally, it was very clear that the safest place for me to birth my baby was at home.

[MNHall]

I honestly have NO clue, but the way it mentions 2 different styles: "running lock fashion" and "second figure of 8" sounds to me like double. Like I said, I honestly have no idea though.

But, to give you some hope on top of the awesome reasons from happymama2, for my first provider is the one that did my c/s, my 2nd provider agreed to do a VBAC but never even asked for my c/s records. Now my 3rd provider (yup, switched again just looking for the best), the only notes he has on my previous births are the ones that came out of my mouth, my opinion, my experience from my end, and my point of view. I'm SURE he knows I don't have all of the details, but he too didn't ask for my c/s notes! So, really makes me wonder how much it matters to the provider about double or single suture!

[LemonPie]

Originally Posted by claudi81

The uterine incision was closed with 0-Vicryl in a running lock fashion with good hemostasis. A second figure-of-eight was used in the midline to achieve hemostasis. The uterus was firm with P insfusion. There was normal pelvic anatomy.....etc...

I ran this past my DH who is a family practitioner. He said it sounds like a single-layer, but it's not specified so he can't say for sure. He said the line about the "second figure-of-eight" means that there was probably still a place on the suture line bleeding after he stitched, so he went back and 'reinforced' that area with a figure-of-eight stitch to stop the bleeding there.

As I understand it, there's no good evidence for double closure over single closure. Some think the double might actually cause more weakness because the uterus is punctured in twice as many places. I do know lots of single-layer closures go on to have VBACs.

[AlexisT]

Originally Posted by HappyMommy2

This is not true. It should be!!! But it isn't. Even at the most natural-minded hospitals.

Actually, it's a good thing it's not true. Without pitocin, some women would be forced to have repeat C sections. No woman should have to have a pit induction, but it's a valuable option to have. Foley inductions may be safer, but can only be done under limited circumstances.

It's about tradeoffs. When we stopped using prostaglandins for VBACs, the rate went down (and would have even if it had not been accompanied by a general fear of VBAC). That was a tradeoff worth making, because the risk of uterine rupture was unacceptably high. The risk with pitocin is much lower.

If it were all about the UR rate, no one would VBAC at all--because the risk of rupture is always higher with VBAC, even a completely natural one. But that's not the only thing we consider.

[claudi81]

Originally Posted by AlexisT

Actually, it's a good thing it's not true. Without pitocin, some women would be forced to have repeat C sections. No woman should have to have a pit induction, but it's a valuable option to have. Foley inductions may be safer, but can only be done under limited circumstances.

It's about tradeoffs. When we stopped using prostaglandins for VBACs, the rate went down (and would have even if it had not been accompanied by a general fear of VBAC). That was a tradeoff worth making, because the risk of uterine rupture was unacceptably high. The risk with pitocin is much lower.

If it were all about the UR rate, no one would VBAC at all--because the risk of rupture is always higher with VBAC, even a completely natural one. But that's not the only thing we consider.

I agree, I think the main problem with the use of pit is that is that it has been abused, and used for too many unneccesary reasons and in a much too high dosage that caused many problems and unnessesary c-sections. However, I do believe that for some medical reasons a pregnancy must come to an end and if the mother is only left with another c-section instead of some very carefull use of pit used with caution should be an option. The unfortunate thing is OBs do not have the time to take things slowly and handle things with patience.

In most hospitals the (ab)use of pit gets the brithing mom faster out of the labor and delivery either by progressing rapidldy scarry fast or by its side effects leading to a 30 min c-section. So yeah it has been abused and could be used wisely though

[claudi81]

Originally Posted by LemonPie

I ran this past my DH who is a family practitioner. He said it sounds like a single-layer, but it's not specified so he can't say for sure. He said the line about the "second figure-of-eight" means that there was probably still a place on the suture line bleeding after he stitched, so he went back and 'reinforced' that area with a figure-of-eight stitch to stop the bleeding there.

As I understand it, there's no good evidence for double closure over single closure. Some think the double might actually cause more weakness because the uterus is punctured in twice as many places. I do know lots of single-layer closures go on to have VBACs.

Thank you, the way you the describe it would make sense to me.

Do you or anyone else know if they open the old scar on the uterus just like they do withthe outside one?? They must have found the old scar in my case cause I did ask the OB if my old scar was intact or extremely thin or so and the Ob said no not really it looked OK. I always thought they open up the old scar and remove some of the scartissue to have strong tissue to stitch back together??? Is that correct?

[thepeach80]

A lot of Drs do repeat c/s in a slightly different spot so you can end up w/ 2 scars, it just depends on the Dr.

I've had pitocin w/ 2 of my VBACs.

[dlm194]

I just looked at the ICAN conference handout on single vs double layers. It describes figure 8 stitches as "used to “repair” small areas where there is bleeding or the edges of the incision aren’t put together well. " The process of repair little areas that are still bleeding is the process of achieving good hemostatsis. So it sounds like part of your uterus has an extra or double layer but not the whole incision.

[claudi81]

so its half of a double layer?? wow is that a good thing or a bad thing and how will I know if they opened up the old scar or if I got a new one, the OB that did the surgery was able to answer that the scar was not unusually thin, does it mean she opened it or looked at it ?? I will never know how well of a shape my uter us is and it kind of makes me sad

[thepeach80]

Why do you want to know the shape of your uterus? You're going to be attempting a VBA2C and according to ACOG that's fine, doesn't so much matter as long as the scars are low transverse. Either you have a supportive provider or you don't. I haven't known many you can convince w/ old charts and even what ACOG says.

[HappyMommy2]

Originally Posted by thepeach80

Why do you want to know the shape of your uterus? You're going to be attempting a VBA2C and according to ACOG that's fine, doesn't so much matter as long as the scars are low transverse. Either you have a supportive provider or you don't. I haven't known many you can convince w/ old charts and even what ACOG says.

Agreed. I discussed my fears and concerns with my midwife, and she was not concerned about having the single layer.

It is more about the future at this point. Planning for your vba2c will help you get thru the anger phase and into the "I can do this" phase.

Good luck strong mama!

[danipoppins]

Hmmm... I split my knee open when I was about 11 - should have had stitches by never did. It healed with a pretty nasty, ragged scar. That was 24 years ago and my knee has yet to burst open when I bend it or crouch down.

Breath deeply mama - trust that your body healed perfectly and that your uterus is strong and whole and more than able to withstand the rigors of labor and birth.

Gestate in peace...

[claudi81]

I appreciate all your kind words they help a lot

Its just I need to find some sort of confidence in myself and my body before I can even begin the battle of provider hunt and convincing them too and find someone supportive.

But you are right I need to believe that I am OK and able to do this, its just so hard, I know how much I want to do it, but I feel so broken and scared up not even know for sure how careful they stitched me up, if they did not care enough to write it well enough

On top of all this I never even had any feelings of success before, never went into labor on my own, never dialated beyon 1 cm ....I think I need some more self confidence I know!!

We all are weighing our riscs out don't we and do what we feel is safest and best, but I feel like I am not able to do that with all the mixed information I am getting. I am pregnant to soon after only 6-7 months past the 2nd c-section, I never this and that, I just feel overwhelmed having to go through this again.

[roadfamily6now]

My 1st VBAC was just 14 months after my c-section. 15 years later I got my records and discovered that i had a single layer closure along with pitocin along, an internal monitor, IV, external monitors and an epidural.

With all those interventions, I just figure I was darn lucky to have a vaginal birth at all!