How common is this (manual uterine inspection post-VBAC)?

[mama2soren]

I had my first real appt today with my hospital based CNM group.  I asked all my questions about how they might care for VBAC labors differently than non-VBAC's.  Of course I expected the continuous monitoring, was not surprised (though I was disappointed) about the "mandatory" Hep-loc, but I was shocked when the CNM said that their back-up doc would always request that the CNM do a manual inspection of the uterine cavity after birth to search for scar dehiscence.  I looked at her like she was crazy, which made her nervous, I think.

I know it is my right to refuse treatments, and I would certainly refuse this type of "care" unless I had some very convincing other reasons to suspect a true scar separation (hello... pain?  bleeding?).  But, my main concern is that this is under their umbrella of "normal" VBAC care.  I've never heard of a manual inspection being routine, even after years of L&D nursing.  I worry about what other harmful, non-evidence-based practices might fall under such an umbrella.

I live in a very  non-progressive area when it comes to birth.  There are few hospital-based care providers around that even do VBACs.  Homebirth midwives practice very much under the radar.  My reason for starting with CNM/hospital care was to help allay my fears of rupture.  Now, homebirth might be sounding less scary to me.  That's another thread, I suppose.

So, mamas, help me know how out of the ordinary this "care" is...

[LiLStar]

I hear of it happening from time to time, but I don't think its that common? I do know that it is dangerous, and there is the potential to actually cause a rupture by poking around where they don't belong! If pp bleeding is normal, pain is normal, uterus is shrinking the way it should, no signs of infection, etc, then there is no reason to intervene

[jenniro]

I agree.  I don't remember where I read it b/c I am researching the hell out of VBACs right now :)  Anyway, docs used to do this 20-30 years ago, when VBAC was more common.  But they discovered that it caused more problems, i.e. bleeding, infection, and even if there was a window, it healed and seemed to have no bearing on future pregnancies.  Old practice and not in any way evidence based. 

[neveraim]

I've heard of it and agree that it is completely unnecessary as a routine procedure.  The continuous monitoring is also unnecessary.. blech.  I understand the hep lock and it's really not that big of a deal since it doesn't tether you to anything.

If you even think you would consider home birth, I suggest you go and interview a few midwives.  It never hurts to talk to someone.

The risk of uterine rupture is very low.  7-8 births per 1000, that includes all levels of rupture...from a window (thinning of the uterus) up to a complete rupture.  You have to do what you feel comfortable with.

I did have my VBA3C in the hospital, so I'm not against hospital birth...but I had a fantastic provider who loves NCB with a 92% VBAC success rate.  I was right to follow my instincts and choose him because I would have ended up transferring and getting another c/s if I'd tried at home.

Explore ALL your options and then weigh the risk and benefit...I wish you the best on your journey!!

[soccerchic21]

I just had a VBAC and this was not done nor mentioned/offered to me at all. Is it possible to go through with your VBAC then when the time comes refuse this procedure?

[roadfamily6now]

No

this is not common at all. I find it rather disturbing as well. So let's say a mom was having a natural drug free labor and they did this! What kind of pain would she have to endure? OMG! It's unthinkable.

During my 3rd or 4th delivery (sorry I cannot recall) I has something after birth they needed to check, it was 8-10 years ago and it's a pretty foggy memory so bare with me.... But they gave me some demerol for the pain (drug free birth) and I was knocked out for like 30 minutes. I have absolutely no idea what was done to me and my medical records are unclear (although I have them, so I'll probably go reread them) but I fear they did a manual exploration of my uterus at this time. :(

[neveraim]

Originally Posted by roadfamily6now 

 So let's say a mom was having a natural drug free labor and they did this! What kind of pain would she have to endure? OMG! It's unthinkable.

 I actually had forceps and manual placenta removal natural/drug free!  It hurt like hell but I was sooooo very thankful for the option vs. another c/section....but I was ok with it and trusted my provider.  I cannot imagine the PTSD you'd have if you protested the procedure and it was done anyway.

[buckeyedoc]

I think it's considered unnecessary and "out of fashion". That said, my very pro-VBAC OB/Gyn did it after my delivery. He asked if it was OK (I was caught off guard and said yes), and he applied gentle pressure so that it really didn't hurt any worse than a cervical check. I was unmedicated. I think he was being overly cautious because his most recent rupture had been detected post-delivery when a mother delivered abdominal fat after the placenta, and then they had to repair it and give antibiotics because of the risk of peritonitis from bacteria going from vagina to abdominal fat to abdomen. It isn't a deal-breaker for me, but I would prefer not having it done.  

[neveraim]

Quote:

Originally Posted by buckeyedoc 

I think it's considered unnecessary and "out of fashion". That said, my very pro-VBAC OB/Gyn did it after my delivery. He asked if it was OK (I was caught off guard and said yes), and he applied gentle pressure so that it really didn't hurt any worse than a cervical check. I was unmedicated.

Thank you for that!  I think it's important for women to understand that if something like this or manual placenta removal, etc needs to be done (not saying that this is necessary at all) and you are unmedicated, if you have a caring provider, someone you trust, who is careful and gentle with you, it doesn't have to be THAT bad.  I'm only saying that because I've heard doulas talk about seeing manual removals, etc. and being horrified and it being the worst thing ever, etc.  It scares the crap out of women...but honestly...a hand isn't that bad after you've just given birth...gross to think about, but it's true.  My doctor actually reached his arm inside me and was holding my softball sized fibroid...unmedicated.  He had to get my attention and let me know what was happening.  I knew he was working 'down there' but didn't know (and didn't really care) what was happening.  I was just glad my baby was out, and all I really wanted to do was rest.

I agree with Katie...not a deal breaker, but I would not really want it done unless there was a reason.