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Explain double suturing to me!

post #1 of 11
Thread Starter 
I am worried that I am going to have a c-section, so I am trying to explain to my husband what double suturing is so that if I do have a c-section he can make sure that the doctor closes me up right so that I can have a VBAC in the future.

I've found this describing double sutures:
first continuous locking stitch followed by a continuous imbricating layer

but I have no idea what it means.

Is double suturing closing two different layers off separately or is it closing everything off and then sewing it up again to make sure everything is really well closed?

Sorry for the stupid question. I tried to google and search on this forum, but came up with a lot of medical jargon that I just can't understand.
post #2 of 11
**Disclaimer: My keyboard sticks. I try to be mindful, if you try to be patient.

Double suturing is sewing the uterus closed, then stitching over the incision a second time.

I'm wondering where you got your information....I'm guessing Ina May?

Studies have shown that there's no significant increase in rupture on a single than a double. Those that show some in Most doctors I know/work with do single sutures.

Either type can have (or attempt) a VBAC. The biggest risk BY FAR for uterine rupture in a VBAC is induction/augmentation with cervidil, *cytotec (nasty stuff), or pitocin.

Another big risk is the time between pregnancies. If you were to get pregnant within one year of a c-section, your chances of rupture are increased. I think (not sure) but at least 2 years is the recommended time to wait.

...and to be honest...I can't imagine a scene in the OR, where dad says from behind his blue drape "Make sure you do a double suture!" and the surgeon saying from his/her side of the drape "Sure thing! Good idea."
post #3 of 11
Quote:
Originally Posted by Sock View Post
I am trying to explain to my husband what double suturing is so that if I do have a c-section he can make sure that the doctor closes me up right so that I can have a VBAC in the future.
I'd watch out there. There is no definitive evidence that a double layer suture reduces the risk of rupture. If your doctor does not do them (because he knows they are unnecessary), your husband is only going to piss him off insisting that he, a lay person, knows more than the doctor about what constitutes closing you up "right" means.

This is a conversation that you need to have with the doctor and make your wishes known before the surgery, preferably before labor.
post #4 of 11
why do you think you will need a c-section? the best way to ensure more vaginal births is to have one this time
post #5 of 11
Quote:
Originally Posted by CookieMonsterMommy View Post
...and to be honest...I can't imagine a scene in the OR, where dad says from behind his blue drape "Make sure you do a double suture!" and the surgeon saying from his/her side of the drape "Sure thing! Good idea."
I agree. As another poster said...this is a discussion that should be held with your OB prenatally.

I've actually heard that double layer is *worse* for VBAC because it introduces more trauma to the uterus--more needle punctures. Because of how the uterus shrinks down so much after the birth, the sutures in the uterus--whether they be single or double layer--are very quickly hanging limp and loose and doing very little to hold the uterus together--it holds itself together via clotting. It's actually pretty amazing that it holds together at all considering how much movement it goes through with the contractions to shrink it back down to size.

Jenn
post #6 of 11
Thread Starter 
Quote:
..and to be honest...I can't imagine a scene in the OR, where dad says from behind his blue drape "Make sure you do a double suture!" and the surgeon saying from his/her side of the drape "Sure thing! Good idea."
Tee hee! My husband is going to act as the translator. I am birthing in a foreign country (for me, at least), and while I can communicate at a basic level (heck, even an intermediate level), I don't know if I would be able to talk about suturing with the doctor (especially if I am preoccupied with birth).

I pray that I can have a natural birth, but I need to be prepared for anything, and that means making sure that my husband knows what I want, and practicing my Chinese with my husband so that I can tell the doctors what I want.

The c-section rate here is aroujnd 75% (I've heard that about half of those are elective c-sections or c-sections where the mother can't handle the pain and asks half way through for one), so that still leaves me with a 35% chance...

Thanks for all of your help. I was just concerned because I read a thread (maybe on MDC) where a woman was having problems finding a midwife for a HBAC because she was single sutured.
post #7 of 11
That's just the thing. Midwives have been scared into thinking it's not safe to take a single-layer suture while at the same times doctors continue to do them because there is no definitive evidence that it's necessary. Who is following evidence-based practice now? Ina May Gaskin has been very vocal about the singler layer suture not being safe for VBAC, and as goes the Farm so goes most everyone else. So it might be true that you will have trouble finding a homebirth midwife after the surgery, but unfortunately that's not the doctors' fault.
post #8 of 11
I hate to say this but in Ottawa, anyway, you get a lot of resistance about vbac if you *don't* have a double suture and I'm sure it's like this in many centres. I was trying in the spring to help a mama whose CP group (OB group, there are MWs at that hospital but they can't attend vbacs, long story, huge PITA... fighting it! ) (this is the QCH in Ottawa if any Ontarians are reading) looked her in the face and told her flat out she couldn't have a vbac with a single layer and they "wouldn't do it", and not only would THEY not (them, that GAVE her the single layer suture not 18 months before), they refused to give her a referral to any other OB group.

I was calling around and so was she, and finally she found an OB through her family Dr at a hospital 40 minutes farther from her home (the Civic, which houses the high risk unit) who would do it. He told her she was a great candidate, young and healthy, and he saw no reason she shouldn't go for it. He added that since the study about double suture being so much better had come out of Montreal (2 hours from us), there was a lot of local support for it in order to support colleagues, despite the fact that the results were highly debated.

(Yep, you heard me right, they would rather sacrifice a mama and give her surgery she doesn't need, than fail to support a colleague's bad science.)

So. HERE, it's certainly best to get a double suture if you want a vbac next time. I think what I would do before making a decision about it is - A talk to my provider and see what s/he would *normally* do, and B - tell them this story (perhaps leaving out the specific cities), and ask if s/he can assure you that you will not be facing this purely political problem with the kind of suture that is normal for them.
post #9 of 11
Quote:
Originally Posted by Sock View Post
The c-section rate here is aroujnd 75% (I've heard that about half of those are elective c-sections or c-sections where the mother can't handle the pain and asks half way through for one), so that still leaves me with a 35% chance...
Wow, that's insane, do they not do epidurals or other drugs for pain management? You just get cut open. I'd say that's going from the frying pan into the fire in terms of pain. That sucks!

Anyhow, I had a single layer suture and I did not have a problem with it with either of my VBACs, all my other doctors and midwives did care about was that I had a low transverse incision, so make sure that they're not going to do a vertical incision or anything. I read that the reason that some doctors have gone to single layer suturing is because it is faster and thus there's a lower risk of infection, so I guess I would say ask the doctor what they usually do and take it from there. I guess you don't have the option of finding a care provider that speaks English? That would be really hard for me to not be able to communicate and know what's going on. Good luck!
post #10 of 11
Thread Starter 
Quote:
Originally Posted by oregonbound View Post
Wow, that's insane, do they not do epidurals or other drugs for pain management? You just get cut open. I'd say that's going from the frying pan into the fire in terms of pain. That sucks!
Thanks to everyone for all of the information.

I forgot to say earlier that I won't know who will be delivering the baby until it is actually time to deliver. The doctor I see for prenatals is different than the doctor that will be there when I go into labor.

In China (or in rural China, where I live), there isn't much (or any) childbirth education. I sometimes feel like I am more up to date on current research than my doctors are. Therefore, there is a lot of old wive's tales that get put into practice in the delivery room (and in the recovery room). I think this causes a lot of the c-sections.

Also, epidurals aren't used for pain management for a vaginal delivery. If you get a c-section, you are usually awake, and I think you get a spinal block instead of a epidural.

A third thing is that women (and men) here tend to think doctors and hospitals are the best thing since sliced bread. They don't question anything or even stop to think. My husband and I have come to blows over this several times during this pregnancy. Usually, I can get him to stop and think by telling him that he has to find me one reliable source to back up any claim before I will believe what they are saying.
post #11 of 11
Your experience sounds very foreign. Definitely take the time to learn as much about natural childbirth as you can NOW. Practice different birthing positions with your husband and make sure he feels comfortable helping you into ALL of them, especially squatting positions.

Before my last birth I read lots of books, but did not practice positions with my husband and he was not prepared to take the lead in guiding me through childbirth. My baby was posterior (facing the wrong way) and the only help the dr and nurses could offer was an epidural. My husband encouraged me to walk, but had not practiced massaging my back or helping me get into alternative laboring positions. i felt scared and alone and my husband felt like he did not have the tools to help me. I recognize now that I could have helped give him those tools by making him read the books I was reading and PRACTICING labor with him so that we knew what each position felt like.

Obviously, you will not have access to a doula, so you and your husband will have to practice by yourselves to get through the birth.

It really is true that the rest of your births will be MUCH easier and less risky for you and your future babies if you don't get a c-section this time.

BEST OF LUCK!!
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