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Originally Posted by egoldber
The 12/04 NEJM article put the UR stats as .4% for unaugmented/uninduced labor, .9% for augmented labor and 1% for induced labors. Most studies I have seen quote VBAC success rates (granted, usually hospital VBAC success rates) at 70% to 80%.
Originally Posted by reader
But that doesn't mean that the 20-30% are uterine ruptures, obviously.
|... just think for a minute. If you were in a terrible car
accident and had to have a piece of metal removed from your leg (sorry
for the visual there, ugh) .... say they had to cut in to get it.
Then they stitch you all back up. What do you expect the scar to do?
Do you expect it to fall open when you start to walk? No? Well, okay
maybe normal walking is okay, but what about running? Maybe running
will cause it to fall open. No? Alright maybe not normal running, but
I bet a marathon would cause enough pressure to just rip it open,
right? Hmmmm ... wait a second, maybe not. Perhaps if they hooked the
repaired leg up to a machine that mimicked running, it could cause
problems ... esp a machine that pulled the muscle further than normal
use would, that didn't do it "naturally" (kind of like pitocin!). But
for regular use, we expect ourselves to stay shut. We expect wounds to
have healed. We expect normal function to be obtainable for
If we get a cut or have stitches anywhere else on our bodies, we expect
it to stay shut. If we looked at the doctor and said, "I don't think
this is going to stay shut", they would be highly offended because we
were doubting their skill as a surgeon AND we would be turning our
noses up at our body's ability to heal and reams of scientific evidence
that it does.
But then when we have a c-section, we look at that and think, OH NO
this thing isn't going to hold!!! Do you think the surgeon stitched
you up? Do you think s/he is a skilled surgeon? If your old surgeon
questions the integrity of your healing, then he or she is expressing a
complete lack of confidence in his/her work. Point that out. They
need to think about this. If your new OB or midwife is questioning the
integrity of your womb, then they need to be confronted about doubting
the surgical skill of your previous surgeon. If they doubt his or her
skill that seriously, perhaps they need to express their concern to the
Anytime someone is stitched back together the ultimate goal is to
prepare the organ or muscle or whatever to perform its normal function.
I have had 2 c-sections. One was with my first and one was with my
fifth. The rest have been hbacs. All my births up through the second
c-section were to fairly tiny babies, weighing between 6.5 and 8
pounds. My sixth ... the fresh vbac who was testing out the surgeon's
skill ... was 11 pounds 4 ounces. I had some nifty pushing
contractions. And I can compliment my surgeon for a job well done
because her work held up under Normal Use. Giving birth is Normal Use,
yes even when giving birth to an 11 pounder. It is exactly what the
uterus was created to do. If we expect that a straightforward incision
and stitching should restore other muscles to regular use, then why do
we doubt the womb?
I will tell you what finally set my own mind to ease this last pg
because yes for the first time ever, I was actually nervous about UR
(something about hanging around ICAN where it is talked about all the
time, lol ... fear started rubbing off there!). My daughter used to
play with my LUS ... she would push and stretch and wedge herself in.
She would shove her hands right under where my external incision scar
was and do boxing drills. Maybe she could feel the ridge of my
external incision? I don't know. But what I do know is that I felt
very reassured that if she could do all that and it held together, then
what was a little labor?
|Did you read the most recent AAFP guidelines on VBACs? It said that the "immediate access" to anesthesia had not improved outcomes at all and hadn't decreased rupture/mortality rates.|
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