Anyone heard this theory about the uterine incision interfering with dilation?

[justKate]

So the other day, a CNM in my area mentioned to my doula that the uterine scar from a c-section can slow down the cervix's dilation in labor.  I think her idea is that the uterus is contracting less efficiently due to the scar, and somehow that affects dilation.

Anyone heard of anything like this?  I've done a lot of reading about VBACs but hadn't heard this, although I guess it would make sense.

Any thoughts?

[JaimeF]

No I never heard of this.  From what I see, women who vbac do just fine.

[obdoc]

OB doc for 23 years and this is utter rubbish!!!   The scar is in the lower uterine segment---not the cervix---pretty basic anatomy.

[justKate]

Yeah it didn't make a lot of sense to me either.  Good to hear because dilation was one thing that I DIDN'T have trouble with last time.  :)

Thanks for the reassurance!

[TrumpetMom]

If it helps any, my 2 hospital births were 24+ hour not dilating past 6 cm. My HBA2C was less than 12 hours start to finish. My CNM never said anything about that.

Good luck!

[Blue Eyed Baby]

justKate- This may be what you are referencing ... She's not referring to Cesarean scarring in particular, what this mainly talks about is scarring from Cervical Cancer and LEEP procedures, and uterine scarring of unknown or other etiology. http://www.birthresourcenetwork.org/blog/98-cervical-scar-tissue-a-big-issue-that-no-one-is-talking-about

[Blue Eyed Baby]

obDoc, would you mind my asking you a few questions? When you're online of course ;-D

[roadfamily6now]

I have never heard of a C-section scar interfering with Cervical Dilation. Sounds like that so-called midwife had her facts confused.

[obdoc]

Yes----LEEP can interfer with dilation ---but have seen this many times and it is easily corrected and I would venture to say would never be the cause of a C. Section.  I have used a speculum and a long kelly clamp and gently put it just inside the os and opened the clamp---it i stronger than fingers and usually will "crack" the scar and next thing you know patient is almost fully dilated.

Other thing is --could the OP have misheard what was said??

[justKate]

Quote:

Originally Posted by obdoc 

Other thing is --could the OP have misheard what was said??

Yeah, I definitely could have.  This was said by a hospital midwife (not one at my hospital) to my doula and casually mentioned to me. So second hand, but it concerned me that my doula was concerned enough to mention it, I guess.  Maybe my doula misunderstood what was said.  Anyway I didn't want to cause alarm, I was just confused.... 

As far as my VBAC, I got to 10 cm last time, so I'm not really worried about dilation.  My concern is my ability to get a baby in a position that will allow me to push her out.  Or maybe my ability to push out a baby in general?  But that's another thread!  

[Blue Eyed Baby]

justKate, I am 100% with you, I dilated to 10 with baby number 3 (first VBAC attempt, 2nd labor) but she would not descend past 0 due to being OP. If you check out Spinningbabies.com they have awesome information, I actually used one of the techniques listed to flip my attempted VBAC baby back into a Cephalic lie (unfortunately we didn't recognize that she was OP until late in labor.) Also seeing a Webster-certified Chiro can help (the Webster Technique has an 82%success rate.) Don't doubt your ability to push out a baby, you cannot know for sure until you make it that far, you must have faith in yourself and your bodys abilities. Speaking for myself I know that once I can get my next baby past 0 station I'll be able to push baby out.

Originally Posted by justKate 

Quote:

Yeah, I definitely could have.  This was said by a hospital midwife (not one at my hospital) to my doula and casually mentioned to me. So second hand, but it concerned me that my doula was concerned enough to mention it, I guess.  Maybe my doula misunderstood what was said.  Anyway I didn't want to cause alarm, I was just confused.... 

As far as my VBAC, I got to 10 cm last time, so I'm not really worried about dilation.  My concern is my ability to get a baby in a position that will allow me to push her out.  Or maybe my ability to push out a baby in general?  But that's another thread!  

[Blue Eyed Baby]

Originally Posted by obdoc 

OB doc for 23 years and this is utter rubbish!!!   The scar is in the lower uterine segment---not the cervix---pretty basic anatomy.

Obdoc, can you answer something for me? I cae very close to delivering my first attempted VBAC baby vaginally (VBA2C), the only thing thsat prevented that was that she was OP and wouldnot budge from 0 station. What I would like to know is: How long do I need to wait tosafely attempt another VBAC (baby girl will be 9 months on the 14th.) I have an amazing and incredibly supportive Peri (high-risk due to a raging case of severe Pre-e Pre-e with baby number 1 in 2004, necessitating delivery at 33 weeks), he's already approved me for a VBA3C at my 6 week PP visit, but I didn't ask and he didn't say, how long I would need to wait to ensure optimal healing and a safe delivery.

[obdoc]

Most OBs suggest 18 month interval but there isn't a lot of research.  It is believed that an abdominal wound heals in about 3 months and "remodeling"---the process of the scar softening up and becoming more like the surrounding tissue takes about 6 months----I guess we like to see a longer interval for the uterus but I would not deny a VBAC if a woman got pregnant in less than a year.

[member234098]

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Edited by member234098 - 5/25/12 at 11:03pm

[obdoc]

you are correct that the alarming increase in C. Sections is causing an increase in placenta previa and accreta--but barring that--the issue of time of VBAC due to scar is another issue.  I don't know of any studies that shows a TIME factor for this---I would think it would be the scar issue itself--independent of time.

[VBACmama4]

Wanted to add a quick note: maybe the midwife's comment was misstated. I had a c-section with my first child (horrible experience, but that's another topic) and with my 2 VBAC's I had a "lip" of cervix directly under the area of scar tissue that wouldn't dilate completely. The rest of the cervix was clear but that section was stubbornly not budging even after hours of hard labor. I had to push both times to get my baby past it in order for them to descend into the birth canal. Maybe that was what she was referring to? It did add time to my labor because I didn't want to risk tearing by having the cervix forced open. Now that I have that knowledge, my third VBAC next month should be easier to handle since now I know I have that issue to cope with asap during labor.