does this really matter?

[shmmommy]

I was just wondering if you guys could give me some insight on this. I had an emergency c-section in 2007 to deliver my twins. I was given a low-transverse incision, which healed just fine. Fast forward to now: I am trying to conceive #4 (I also have a 4 year old who was born vaginally.) and really, really want a VBAC this time. I am also debating having a homebirth, but I'm not 100% sure on that one yet. I spoke with a midwife who does home VBACs, and she advised me to get my surgery report and see how they stitched me back up. I discovered that I was closed up with a single suture, using chromic. I have read a lot about the debate over the safety of having a VBAC when they have sewed you up using this type of closure, and this material. The midwife told me that it really doesn't matter a great deal, that what matters more is that I had the low-transverse incision, and that it's been over 3 years since the c-section, but I guess I'm a little scared. So do you think this really matters? Should I go ahead and attempt a VBAC?

[MsBlack]

NO, it really doesn't matter, especially because you have already vbac'ed! There is just no real evidence that single-layer suture is the cause of worse outcomes/more UR.

I think you will be able to find good info here:

www.ican-online.org

also, maybe you can find an ICAN chapter near you--to have support and info in person (or at least by phone).

Your risk of UR does not 'disappear', but it does reduce greatly once you have already vbac'ed. UR rates for reasonably healthy women are very low anyway (1 in 200 or .5%--and the majority of those ruptures are very minor). I don't know the stats (surely ICAN does) but that 'usual risk for primary vbac' reduces a lot once you've already vbac'ed.

good luck!

[ShwarmaQueen]

Sounds like you're a great candidate for VBAC, especially since you've already delivered vaginally.

[texmati]

subbing, because I'm wondering the same thing. I'm talking to my ob about this today.

[HappyMommy2]

Search here in the VBAC section for "suture"... there are lots of us that have been in your situation, and gone on to successfully HBAC.

Good luck mama!!

[liberal_chick]

I had the same type of closure (single w/chromic) and have had two great HBACs since. It doesn't matter. Go for it!

[shmmommy]

I haven't already VBAC'd. My first birth was vaginal. My second was c-section. I am now contemplating the VBAC. But you are right that it's probably not something I should really worry about.

[kltroy]

No it doesn't matter too much. The double suture has about a 0.5% rupture rate. The single has maybe a 0.6-0.7% rupture rate. Very small difference in the grand scheme of things, and many studies failed to find a significant difference. Happy VBACing!

[MNHall]

I haven't done a lot of research on this myself, but I have seen over and over again here that a single suture is no big deal. I know my OB actually just did a VBA2C on a woman with a single suture!

And I think the GREAT thing about your "situation", is you have a vaginal birth under your belt. So, you've already proven your pelvis. Sure, you haven't VBAC'd, but you've vagainally birthed which means no one has a right to argue that you are fully capable of birthing this baby vaginally as well!!!

YAY!!!!!

[kltroy]

The other thing to remember is that the generalized "UR rate" of 0.7% includes ALL women. This means ALL single and double layer sutures, ALL inductions or augmentations that are considered acceptable right now (pitocin and cervidil included) - EVERYTHING. So while some studies have found higher rates of UR with single layer, ON AVERAGE there's still only a 0.7% rate. There are other surgical advantages to using a single layer (significantly less blood loss, for example), which is why it's done.

[dlm194]

To be honest with you, the studies that showed higher rates of uterine rupture were comparisons of single layer chromic to double layer chromic. Most providers use polyglactin (Vicryl) suturing today which has a higher tensile strength than chromic. Studies of single vs double layer involving Vicryl have not shown big differences in rates of uterine rupture. So, yes, there is a bigger concern with a single layer chromic suture.

HOWEVER..... there are only 2 studies that looked at single layer chromic vs double layer chromic. In one case (the Gyamfi study), the single layer group consisted of 35 subjects vs 948 in the double layer group. The study was done in 1 hospital which says (to me) the doctors were not particularly comfortable or skilled at single layer sutures. In addition to the single layer and the type of suture material, there is also the method of suturing which can make a difference (interlocking, non-locking, simple continous and figure-of-8). The Gyamfi study used an interlocking stitch which contricts blood flow a bit more than something like a simple continuous. In addition to everything else, Gymafi did a lot of inductions with cytotec which is a big no-no with VBACs.

In the 2nd study (the Bujold study), there were 489 in then single layer group vs 1491 in the double layer group. Again, both groups had chromic-type sutures but 15 out of the 23 total ruptures in the study were in patients who were augmented with pitocin (I don't think it said how much pitocin was used).

So the answer is not terribly clear cut. Since you've had a vaginal birth already, you are an excellent candidate for VBAC. The fact is that no one can tell you your true "odds" of uterine rupture since it's hard to qualify surgeon skill and the risk in an totally spontaneous labor (which is obviously the plan for home birth). However, you're setting up the least risky scenerio by opting for a totally spontaneous labor.

Ruptures don't necessarily happen very quickly either so I'd also take into account how far away the hospital it. Can you get there in a reasonable amount of time if you start bleeding, have breakthrough pain or notice non-recovering fetal decels?

[Mamatoabunch]

I had my twins by c/s 16 years ago. I do not know what type of suturing I had. I have since had 8 VBACs, all at home.

[buckeyedoc]

I also had a single layer closure. I switched practices to get my VBAC, and the new provider looked over the report and said, "Eh, I prefer double-layer closure, but it's not a big deal." No scar problems at all when I had my VBAC.