When I had my VBAC in 2009, if I remember correctly, it was preferable to have had your uterus closed w/ a double layer of sutures that were running/non-interlocking and not done with catgut. Does anyone know if these are all still what doctors want to see or what studies show to be safest? Am I missing anything major that's come up in the last few years? I don't have time to redo all the research I did last time around! I want to be sure that if I have to have another c-section that I'll still be a candidate for VBACing again, should we have another child.
Thanks in advance!
This is from 2004, but seems to present a reasonable analysis.
"After looking at all the available information on this topic, we are left with the conclusion that it is unclear as to whether uterine rupture rates are impacted by uterine closure techniques. Out of eleven published studies which looked at uterine rupture or scar integrity, only one showed an increase in uterine rupture associated with single-layer closure. The picture is clearer with regard to abnormal placentation; while only 3 studies looked at this potential complication, none saw any increase in the rate of previa or accreta associated with single-layer closure. It is clear that the immediate post-operative recovery after single-layer closure is better than that after double-layer closure. If we are going to assume anything, it seems reasonable to assume that less inflammation, less infection, less endometritis, less hemorrhage can only improve healing. It does not seem reasonable to assume that a single-layer closure automatically risks a woman out of the birth of her choice when the data simply do not support that conclusion, no matter what stories may have been told to the contrary."
I think you will always be a candidate for VBAC2 to some people and not to others. The medical community changes its mind all the time. A case in point: when I had baby #1, breech was "totally dangerous." And now the Canadian version of the ACOG says every breech baby is a safe vaginal birth candidate. Go figure.
The ACOG also says that women with two low horizonal incisions should be candidates for VBAC unless there are other major issues besides your scar. But your odds of getting a VBAC will obviously vary by care provider.
The SOGC (Canadian equivalent of ACOG) did not say "all breeches" are candidate for vaginal delivery.
Rather, the point of the statement was that select moms with select breech babies, in the optimal position, of the optimal size, in the optimal care centre with expierienced care providers may consider a vaginal delivery for breech after reviewing the evidence and allowing for informed choice. The purpose was not to force c-sections for breech, but to carefully consider why a vaginal delivery or a c-section was going to be the planned route of delivery. It was also to encourage centres to allow women to have an attempt for a vaginal breech delivery, if the circumstances are "low risk". However, this "low risk" for a breech does not mean they are low risk pregnancies, but rather this is the best case senario for a successful vaginal breech without maternal or infant harm. The goal is to select women with the highist likelihood of success (the Term Breech Study showed the greatest maternal risk for an emergency c-section in labour), with the least risk for the baby.
Here in Canada, I do discuss vaginal breech with women who meet criteria. Most choose a primary c-section. A few attempt a breech vaginal delivery, but mostly this was women who had vaginal devlieries before or the menonnite population I worked with because one vaginal breech attempt was much less risky that multiple VBAC attempts (this community had large families, so this was a real consideration). Rarely will I have a planned breech vaginal delivery in a primip. However, I have delivered several babies breech, who were unplanned vaginal deliveries, as they presented in advanced labour with optimal maternal and fetal factors and we decided (mom and me) that a vaginal delivery may be less risky at this point. Had I seen them the day before they were in labour, I would have recommended a pre-labour c-section.
I had my vbac in 2010 and had a single row. I'm doing another vbac (how silly, I already had my vbac, this is just a vaginal birth e_e ) this year & no one has said anything. I wouldn't listen anyhow, my uterus has already proven itself :p
DD (4.25.08) DD (4.23.10) DD (10.13.12)