VBAC after vertical incision!!

[MelW]

I work as a maternity nurse and looked after a woman this weekend who had a VBAC with a classical (vertical) uterine scar. She was booked for a repeat c-section, but came in to the hospital in labour...and things progressed very quickly. She hadn't had any labour with her first baby- a c-section done in another country because of breech. I was supposed to be "prepping" her for surgery, but mostly was working to support her through a very fast and intense labour. Whenever I tried to turn away to get paperwork, med, etc. done for the prep- she would grab my arm or hand tightly and beg me to stay and help her with the contractions. By the time the OB arrived she was fully dilated, and luckily he had the sense to "let" (hate that kind of language...but it really does reflect attitudes in the hospital- lots of OBs wouldn't have "let" her) her birth vaginally.

Really I don't know that they would have had time for a c-section anyways- she probably would have pushed her baby out in the operating room. The charge nurse and the anaesthetist were a little stressed by the whole situation...30% change of uterine rupture, blah, blah...

She had an amazing, though unexepected VBAC experience. She was totally surprised by the speed and intensity of the labour and birth, but felt great afterwards. And a beautiful baby, too! I was so glad to be there and be a part of their birth.

[mamabeth]

wow, that's amazing! good for you for supporting her, mama...especially in the middle of what I'm sure was a really anxious situation. :)

[dlm194]

Wow!!! What a great story! Did she express interest in really wanting a vbac? Just wondering if it could also be a mind over matter type thing. :D That's really great though. I can only hope for such a birth once the time comes.

[TurboClaudia]

one of my good friends is currently planning her third VBAC after a cesarean with a classical incision. it will be her first homebirth. she is extremely well educated about all her options and found the right care providers for her during all her pregnancies, although this pregnancy was a bit of a surprise and she was worried about her insurance situation.

it is really nice to hear that a care provider "let" (I hate that language, too...) the mama labor and deliver vaginally.

in peace,
~claudia

[NoraB]

Awesome!

[birthjunkie4ever]

in a previous post, is way off, unless new study has shown otherwise for classical incision. The last I read up on this was a couple of yrs ago, and it was I think like 4-7% for classical incision. If anyone is reading this PLEASE do your homework re.

I was "planning" on vbac with classical incision.....

My very condensed story here.....

I had faternal twins over 10 yrs ago, 1st twin was vag (spon natural birth, 30w gest ), 2nd twin was transverse (likely caused from AROM by dr after 1st birth--us showed head down minutes before), hemmorage, emergency c/s ---general, some compl from suregy too, , didn't meet my twins for days--never met my daughter for 5 days-general, twins 7 scary wks in Nicu---traumatic birth experience and few months afterwords. I had a full bladder--so ended up being cut in surgery too, despite attempts to avoid that. I have a vertical scar on my belly. When I was discharged a DR in practice--it was 10:30 at night, and I just wanted to go meet my babies at the nicu 50+miles away for the first time---wasn't real interested in asking questions to the Dr actually about me), anyhow, he was examining my stomach, incision scar, tells me my uterine scar is vertical, so any further births need to be c/s, nurses also said this...... My point in all this explanation was that I was dealing with the trauma, of the birth and sick babies that I didn't even question anyone re my incision (or read my records), kept saying to people that I was afraid that the report would tell me was incision was worse than I thought so didn't order records---nothing more to know I thought.

I actually didn't think I would go on to have any more children, as I had my hands full the first few yrs with twins who had serious health issues the first
few yrs of life.... fast forward 7+ yrs..... I had attended over 100 births as a doula by then, and took cce training, worked through all the trauma, took responsibility for my choices at the time, ..... AND actually thought about having another child too. Took 2+ yrs of ttc (was over 40y by this time), but it did happen :bouncy

I worked through all the past trauma from the twins birth and those early days/months.... didn't happen overnite though. I knew that I would want to go on and deliver vbac, but always thought I wasn't a regular vbac cuz of my uterine scar (I couldn't understand why someone would even consider a repeat c/s with non-classical, as I was dealing with a classical vbac).

So, I researched much on classical vbac. I was going to do it--, if I had to do it alone. I had birth 4vag (incl 1st twin) before my c/s, so I was pretty comfortable with natural vag birth, just this classical thing was what made the vbac a "bit" more complicated. That is how I know the risk is "slightly' higher. But 30% risk... never heard anything that high in my research, unless something has come out in studies in the last couple of yrs.

I got pg 2yrs ago, and my midwife (friend too at the time), encouraged me to take the final step to deal with the trauma..... GET my records FINALLY ---I was expecting to find worse than the classsical actually, cuz of the transverse presentation--- so I ordered my records--- when I picked them up, I was shaking. I opened them and to my utmost surprise, my Dr ----in great detail---- explained surgery in report, why he did classical outer, not uterine!!! This was in my chart all these yrs...... the doctor in the practice, and nursing staff at the hospital all just assumed I had a classical uterine scar---never read my chart---well either did I! ;)

I went on and had a wonderful hbac..... can't EVEN put into words that experience. My daughter is 15mos now :bouncy

Because of that experience I encourage everyone to do their research re their actual risks of vbac (classical too) and also get your records (surgical notes, nursing notes, all of it) after any c/s..... you might be surprised what you find out :thumb

4%-7% to 30% is a really big difference. I might have thought twice about a vbac with classical at 30%. Any one can quote most recent studies?

I just don't want to give anyone wrong stats ;)

It IS a wonderful story re spont classical vbac in hospital!

birthjunkie4ever

[SKK]

awesome! I would pray to God for a fast, precipitous and unexpected labor like that if and when I have another child!!! :LOL

Glad you got to be a part of that!

[MelW]

birthjunkie4ever- Congrats on your VBAC! We see a lot of women at our hospital from other countries (especially China) who have vertical external scars but actually transverse uterine scars. Those that want to have VBACs usually have get copies of their records to "prove" their transverse scars. The woman that I posted about had originally considered a VBAC, but after getting copies of her records showing a vertical uterine incision was told she was not a "candidate" for VBAC. So mind over matter may certainly have been at play, dlm194.

As for the 30% stat- I have not read any recent research and have no idea where this came from. This was just the number that one of the doctors mentioned in the moment (though I turned it around and thought to myself..70% chance of not rupturing).
Now that you mention 4-7%, this sounds familiar... and much less alarmist. Anyone have good stats at hand???

[BumbleBena]

What a beautiful birth story! :happyt:

According to this site:

http://www.vbac.com/uterine.html

Rarely, a woman may have a classical (vertical) scar in the upper part (the body) of the uterus. This type of incision is used for babies who are in a breech or transverse position, for women who may have a uterine malformation, for premature babies or in extreme circumstances when time is of the essence.

The risk of rupture for this type of scar has been reported to be between 4% and 9%. A classical scar on the thinner and more vulnerable part of the uterus tends to rupture with more intensity and result in more serious complications for mothers and babies. Mothers who have had several children and have a classical uterine scar are at higher risk for uterine rupture.

[stafl]

it was near impossible to find any data on uterine rupture based on previous incision (horizontal versus vertical) at pubmed, but I found this:

Trial of labor after cesarean delivery with a lower-segment, vertical uterine incision: is it safe? (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7778619&query_hl=10)
CONCLUSIONS: Our experience indicates that a mother with a prior low-segment vertical cesarean delivery can undertake a trial of labor with relative maternal-perinatal safety. The likelihood of successful outcome and the incidence of complications are comparable to those of published experience with a trial of labor after a previous low-segment transverse incision.

and

The case for trial of labor in the patient with a prior low-segment vertical cesarean incision. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9240598&query_hl=13)
CONCLUSIONS: In the otherwise uncomplicated pregnancy the patient with one previous nonextended low-segment vertical cesarean incision should be considered to have a prior low-segment scar and as such be a candidate for trial of labor in her current singleton pregnancy. The same care, counseling, and caution should be exercised for this patient as for one with a prior low-segment transverse incision.

So it appears a classical incision is just as safe as a transverse incision, provided it doesn't extend into the top of the uterus.
All of the studies I found that showed an increase in rupture rate failed to control for inductions.

[mollyeilis]

Well, doctors aren't statisticians, nor are they mathematicians, and this was shown in a story told by someone on ICAN. Her doctor said something about a 40% chance of rupture, which is just insanely wrong.

She went, found the studies, and found that it was "a 40% higher chance" of rupture, not a 40% chance. BIG huge difference. Going from .2% as a first-time to .5% as a VBAC (I think she said, though that doesn't appear correct to me) is a 40% greater chance. But it wasn't a situation where 40/100 women were going to rupture.

They aren't statisticians and probably are skimming (or hearing what other people said after skimming), and are hearing and saying the incredibly wrong things...