Classical incision vbac? - Mothering Forums
Forum Jump: 
 
Thread Tools
#1 of 27 Old 08-26-2006, 12:23 AM - Thread Starter
 
wish2B's Avatar
 
Join Date: Aug 2006
Posts: 1
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I was wondering if anyone has had any experience with a classical incision vbac? I know it's highly discouraged because of the increased ur rate but there does not seem to be too much info out there. I've already had 2 vaginal births that were fast and easy.Thoughts?
wish2B is offline  
#2 of 27 Old 08-26-2006, 11:09 AM
 
crunchymomof2's Avatar
 
Join Date: May 2005
Posts: 858
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
My midwifes grandmother had one and went on to have several vaginal births. But of course that was a long tim ago. I dont know personally of any recent cases.
crunchymomof2 is offline  
#3 of 27 Old 08-26-2006, 12:46 PM
 
TurboClaudia's Avatar
 
Join Date: Nov 2003
Location: in a yellow house
Posts: 7,363
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
a very good friend had her first baby at around 31 weeks via cesarean with a classical incision. then she went on to vbac her second baby (born at 33 weeks, but unfortunately died from post-birth complications at 3 weeks of age), vbac her third baby (born at 35 weeks weighing about 5 lbs) and hbac her fourth baby (born at 40 weeks 1 day footling breech and weighing over 8 lbs). it's possible.

~claudia
TurboClaudia is offline  
#4 of 27 Old 08-26-2006, 05:26 PM
 
wifeandmom's Avatar
 
Join Date: Jun 2005
Posts: 1,539
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Anything is possible I suppose.

However, there is a reason you'd have a very, very, very hard time finding any kind of provider willing to attend a VBAC with a history of a vertical or T incision.

Statistically speaking, the *lowest* risk I've ever seen quoted for non-horizontal incisions is 2%. Typically, the stated risk I've seen thrown around is more like 5-8%, with some studies quoting closer to a 10% risk.

Those numbers are the risk of catastrophic rupture BTW.

There simply is not a 2% risk of life threatening event comparable to catastrophic uterine rupture occurring during a scheduled c-section for mom OR baby, much less a 10% risk of something as devestating.

If the potential life threatening risks of scheduled c-section were higher, there might be more providers willing to attend VBACs with such incisions, but when you look simply at the numbers and compare the risk of either mom or baby or both suffering life long consequences and/or death between the two choices, ERCS will win hands down every time for non-horizontal incisions.

Again, there is a reason you'd be very unlikely to find a reputable provider of any kind to attend such a birth.
wifeandmom is offline  
#5 of 27 Old 08-27-2006, 12:12 PM
 
majikfaerie's Avatar
 
Join Date: Jul 2006
Location: State of Confusion
Posts: 20,453
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I really believe that the risks of doing a VBAC with a classical incision are still less than the risks of repeat C-section, with a HBAC the risks are even less.
I think an important consideration is that the major fear is uterine rupture, which is a term used to describe any opening of the previous scar. the problem with this is that the majority of these "ruptures" are totally benign and do not cause any complications for the pregnancy or birth (in fact, many of them occur LONG BEFORE labour begins!)
And even in the small percentage of labours where the dangerous kind of rupture does occur, it is still very rare for there to be any serious complications. It never happens that mother and/or baby dies on the spot.

I'd say the best plan (assuming the mother and baby are healthy) is to go for a homebirth with a good midwife or doula and have easy access to a hospital if needed (even if labouring IN the hospital, they still take 10 - 15 minutes from "descision to incision" in EMERGENCY cases, and often much more.

By reading this signature, you agree to join my cult :nana
Google me, you know you want to mischievous.gif
majikfaerie is offline  
#6 of 27 Old 08-27-2006, 02:41 PM
 
sesta's Avatar
 
Join Date: Jun 2005
Location: Just outside of Toronto, ON
Posts: 104
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I have a classical insicion and am planning a VBA2C! I'm due in 3 weeks!
sesta is offline  
#7 of 27 Old 08-27-2006, 03:23 PM
 
wifeandmom's Avatar
 
Join Date: Jun 2005
Posts: 1,539
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Quote:
Originally Posted by majikfaerie
I really believe that the risks of doing a VBAC with a classical incision are still less than the risks of repeat C-section,

What single life threatening event occurs during an ERCS in a *minimum* of 2% of moms or babies? What about a life threatening event (single event, as lumping ALL life threatening events together for ERCS and trying to compare that to a SINGLE life threatening event, in this case catastrophic UR, with attempted VBAC isn't a fair comparison) that occurs in 5-8% of all moms who undergo ERCS? There simply *isn't* an event that occurs that frequently with ERCS.

Quote:
with a HBAC the risks are even less.
I've honestly never seen any actual research on the risks of UR with classical or T incisions during homebirth. Do you have links to support your claim that it is LESS risky to attempt a VBAC under these conditions? I was under the impression there wasn't even any research to support a plain old VBAC attempt with a *horizontal* incision at home, much less the much riskier overall VBAC attempt with a *NON-horizontal* incision. I'd be interested to read any research you've come across supporting this claim.

Quote:
I think an important consideration is that the major fear is uterine rupture, which is a term used to describe any opening of the previous scar. the problem with this is that the majority of these "ruptures" are totally benign and do not cause any complications for the pregnancy or birth (in fact, many of them occur LONG BEFORE labour begins!)
The rate of CATASTROPHIC rupture with a lower segment HORIZONTAL incision is known to be approximately 1 in 200, or 0.5%.

Of course, these 'openings' or 'windows', like you said, are totally benign and really shouldn't be a part of this discussion.

However, the rate of CATASTROPHIC RUPTURE, meaning the very real possibility of DISASTER for mom and/or baby, is known to be anywhere from 2-10% with a non-horizontal uterine incision. That simply cannot be sugar-coated or denied. That figure is NOT including the 'windows' you are talking about.

Came back to edit cause I was WAY off on what I thought the rates were from the NEJM study. They found a catastrophic rupture rate of 0.7% overall with TOL, ZERO women in the ERCS group experienced catastrophic UR. They also noted a 0.7% rate *in addition to* the ones who experienced catastrophic rupture of women who had 'windows' noted at some point during delivery. They also made note that of course not all women who had a successful VBAC had their scar inspected in any way, so the obvious conclusion is that perhaps even more women had these 'windows' that were asymptomatic, thus undetected, during delivery.



Quote:
It never happens that mother and/or baby dies on the spot.
Really? Never? I'll bet those moms who have dead babies at the end of an attempted VBAC where they do indeed experience a catastrophic rupture would certainly disagree. And really, if the baby 'only' dies a few days later of brain damage suffered during a VBAC attempt (as have more than one baby on this very board), is that supposed to make anybody feel better?
:

Quote:
I'd say the best plan (assuming the mother and baby are healthy) is to go for a homebirth with a good midwife or doula and have easy access to a hospital if needed (even if labouring IN the hospital, they still take 10 - 15 minutes from "descision to incision" in EMERGENCY cases, and often much more.
For a regular VBAC (horizontal incision, 18+ months between c/s and VBAC, one prior section, maybe two), I would say your plan is a reasonable one for some women.

I do have to completely disagree with the '10-15 minutes decision to incision, and often much more' assessment though. Both hospitals I delivered in and every.single.hospital. my DH has ever worked in has the ability to perform a crash c-section with a decision to incision time of 5 minutes tops, and baby is out in under 5 minutes from incision time. That's just under 10 minutes til baby is OUT, assuming of course you are in a hospital with 24/7 OB and anesthetic coverage who know what they are doing.

Of course, even 10 minutes can often be too long if baby is completely cut off from their oxygen supply. Those are the cases where it wouldn't really matter where you were when the catastrophic event occurred in terms of baby's mortality rate.
wifeandmom is offline  
#8 of 27 Old 08-27-2006, 03:51 PM
 
wifeandmom's Avatar
 
Join Date: Jun 2005
Posts: 1,539
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Can't for the life of me figure out how to transfer the whole chart over here, so here are the comparisons between maternal complications during TOL vs. ERCS:

UR: 0.7 vs. 0

Dehiscence ('windows', but are NOT life threatening): 0.7 vs. 0.5

Hysterectomy: 0.2 vs. 0.3

Thromboembolic disease: 0.04 vs. 0.1

Transfusion: 1.7 vs. 1.0

Endometritis: 2.9 vs. 1.8

Maternal death: 0.02 vs. 0.04

Other maternal adverse events: 0.4 vs. 0.3

One or more of the above: 5.5 vs. 3.6


Statistically speaking, a woman undergoing ERCS has a significantly higher chance of having a blood clot (thromboembolic disease). There's also a *slightly* higher risk of hysterectomy and death with ERCS in comparison to the TOL group, but certainly *no where close* to approaching the 2-10% risk of catastrophic rupture with non-horizontal incisions. There is actually *nothing* on the list of complications for ERCS that is even 2% AT ALL when considering single adverse events.

Otherwise, every other adverse event listed occurred more frequently in the TOL group.

They also broke down ruptures into spontaneous labor (0.4), augmented (0.9%), induced with prostaglandins with or without oxytocin (1.4), and oxytocin alone (1.1).

Baby outcomes went like this: 0.08% experienced hypoxic ischemic encephalopathy with TOL, zero with ERCS. Another 0.08% died with TOL, whereas 0.05% died with ERCS.

Obviously more brain damaged babies with TOL considering there were NONE with ERCS. And more dead babies with TOL, although those numbers are very small either way.
wifeandmom is offline  
#9 of 27 Old 08-28-2006, 10:39 AM
 
majikfaerie's Avatar
 
Join Date: Jul 2006
Location: State of Confusion
Posts: 20,453
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Sorry I dont have time to sit down fo ra long and detailed reply...
anyway, VERY SORRY, it is a rare lapse for me to say *always* or *never* on any point. I definately should have written "ALMOST never", but I'm often typing with a small person climning on me. So let me change it to "almost never happens that mother or baby dies on the spot".

And while these terrible tragedies are rare, of those that occur it isn't necessarily *instantaneous*, CPs usually get some warning time.

incedentaly, I was speaking of figures from the book "Silent Knife", which I will look up directly, (rushing now)

I didn't mean to imply that the classical incision is as safe as the lower horizontal incisoin, sorry if I came across like that. Of course the risk is much higher.

By reading this signature, you agree to join my cult :nana
Google me, you know you want to mischievous.gif
majikfaerie is offline  
#10 of 27 Old 08-28-2006, 10:49 AM
 
majikfaerie's Avatar
 
Join Date: Jul 2006
Location: State of Confusion
Posts: 20,453
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
just looked it up quickly,
Quotes "Maternal Mortality in Cesarean Section as Compared to vaginal Delivery", Krone, H.A., Fortschrift Med. 1975
Quote:
Rate of rupture for a classical incision is between 1 and 3 percent.

By reading this signature, you agree to join my cult :nana
Google me, you know you want to mischievous.gif
majikfaerie is offline  
#11 of 27 Old 08-28-2006, 01:37 PM
 
wifeandmom's Avatar
 
Join Date: Jun 2005
Posts: 1,539
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Quote:
Originally Posted by majikfaerie
just looked it up quickly,
Quotes "Maternal Mortality in Cesarean Section as Compared to vaginal Delivery", Krone, H.A., Fortschrift Med. 1975
I prefer to base decisions on medical research a bit newer than 30+ years ago myself.
wifeandmom is offline  
#12 of 27 Old 08-28-2006, 04:18 PM
 
kathan12904's Avatar
 
Join Date: Jun 2006
Location: The heart of progress in Missouri
Posts: 424
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
One of the midwives I am working with had 3 c/s all classical incisions and went on to have 2 more babies at home naturally without complication. There is a posting board somewhere on the web that contains a woman posting throughout her 10th (thats right 10th) pregnancy because she had a t/j shaped incision on her 9th and she ended up with a successful, natural homebirth for #10. These stories are out there, they just don't have the coverage and good pr that all the scary statistics have. Of course you should discuss the concerns and risks you have with your prenatal care provider, but in no way does verticle incision risk you out of a successful vbac. Good luck.

Mom of three spunktastic kiddos, supported by super-partner while dabbling in midwifery and organic farming. Biting off more than I can chew since '03.
kathan12904 is offline  
#13 of 27 Old 08-28-2006, 04:19 PM
 
hollyberry1285's Avatar
 
Join Date: Aug 2006
Posts: 2
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
True, recent research seems to be preferred. However, statistical methods of analysis haven't really changed in 25 years, and the physiology of the uterus by far has not had time to evolve enough to warrant excluding research from the 70's. Humans have been giving birth vaginally for hundreds of thousands of years, so that variable definately hasn't changed. I suppose methods of c/s have changed however, if you want to bring up single-suture vs. double suture. However, single suture closure is bad for uterine ruptures in subsequent pregnancies as well as bad for infection/hemorrhaging after the c/s- so can't really be said to benefit either argument. The 1970's were a long time ago but they weren't the dinosaur ages. I recently graduated from the Univ. of SC w/ my bachelor's in bio. It was still perfectly legit for me to use research from even the 60's, as long as statistical/research methods weren't off (it had to be "good science")- and it couldn't have been disproved by multiple other articles- but that standard goes for research presented in any decade, even in the 21st century. If you guys are going to argue about 1.% points, that's a little nit-picky. Obviously, different articles are going to vary rates because different studies use different sets of women, the sampling population is different, perhaps statistical methods used were different or whatever. I think the point is- Yes, it is a higher UR rate. No, it's not impossible, and is a viable option. Although personally, I would be uncomfortable attempting a VBAC w/ classical in my home. I'd rather be in a hospital where I know they can have the baby out ASAP. Feeling comfortable is a major key to dilation. If you would be stressed out and tense at home from the risks, it would be better for you to go to the hospital IMO.
Also, I thought Silent Knife was an incredible book. It did for the VBAC and home birth movement what "The Feminine Mystique" did for the women's rights movement. It has very legitimate points to it, and the research in it still carries weight, even though it is 30 years old.

Holly
hollyberry1285 is offline  
#14 of 27 Old 08-28-2006, 04:26 PM
 
kathan12904's Avatar
 
Join Date: Jun 2006
Location: The heart of progress in Missouri
Posts: 424
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Quote:
Originally Posted by wifeandmom
I prefer to base decisions on medical research a bit newer than 30+ years ago myself.
It interesting that you say that, because a large number of the obstetrical procedures performed routinely in hospital births today are based upon theories and statistics that date back to the 1960s, even further in some cases. And I personally don't think its any coincidence that that is the approximate time when women stopped allowing themselves to be routinely "knocked out" during the actual birthing stage, but thats not so much documented fact as hypothesis based on research.

Mom of three spunktastic kiddos, supported by super-partner while dabbling in midwifery and organic farming. Biting off more than I can chew since '03.
kathan12904 is offline  
#15 of 27 Old 08-28-2006, 05:52 PM
 
wifeandmom's Avatar
 
Join Date: Jun 2005
Posts: 1,539
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Quote:
Originally Posted by kathan12904
It interesting that you say that, because a large number of the obstetrical procedures performed routinely in hospital births today are based upon theories and statistics that date back to the 1960s, even further in some cases. And I personally don't think its any coincidence that that is the approximate time when women stopped allowing themselves to be routinely "knocked out" during the actual birthing stage, but thats not so much documented fact as hypothesis based on research.
I can assure you that *my* birthing choices were based upon research findings that were current at the time of my births.

I'm not one to take the word of a doctor, any doctor, no matter how good they are, simply because they are a doctor. Nor am I one to do things 'their way' just to appease the masses, as I truly didn't care if they liked my choices or not. It came down to cold, hard facts, something that is terribly difficult to argue with when they happen to disagree or want you (you being the mom) to do it 'their way' when there is nothing to back up 'their way' in the first place.
wifeandmom is offline  
#16 of 27 Old 08-28-2006, 06:09 PM
 
maxmama's Avatar
 
Join Date: May 2006
Location: Ann Arbor/Ypsilanti
Posts: 2,454
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Re: "old" v. "new" research:

In health care (specifically in nursing research, since that's what I'm most familiar with) it is unacceptable to use as a primary source studies more than 5-10 years old, unless they are the ONLY studies available. Clearly, when looking at vertical v. horizontal incision, there are more recent data available. If I tried to use a study from the 1970s in my dissertation, my committee would hand it back to me.

mama to Max (2/02) and Sophie (10/06); wife to my fabulous girl
maxmama is offline  
#17 of 27 Old 08-28-2006, 10:38 PM
 
JanetF's Avatar
 
Join Date: Oct 2004
Location: Australia
Posts: 1,467
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
This is frmo an excellent article on UR by Debby ****** here in Australia. The refs for the whole article are down the bottom and these are just a few excerpts. It's from an ENORMOUS birth after c-sec kit I have which I'm happy to share via email.

Quote:
Which Women Have Ruptures?
Any woman can have a rupture. This includes women who have never had a csec before. The risk to some women is however higher than for other women. Here is a breakdown (refs 1,2,3,5,6,7,10,16,17,,20,21,22,23,27,28):
•Of all women who go into labour the risk of rupture is 0.017 - 0.07%
•Of all women with a previous CSEC the risk of rupture is 0.068 - 1%
•If the previous CSEC was ;
•- classical 4 - 9 %
- horizontal lower segment 0.2 - 1%
- vertical lower segment 1 - 7%
- T or J incision 4 - 9%
•The risk for women who have had five or more pregnancies (grand multiparity) is also recorded as being higher there were no quoted statistics in any of the articles. In ref 20 they had 13 ruptures and 2 of these were due to grand multiparity.
•There is also a risk of rupture where there is a trauma to the abdomen. A number of the studies cited ruptures resulting from vehicle accidents.
•If you had a first trimester abortion (at some time) your risk of rupture is 1%
•If you have had a hysterotomy or uterine operation (eg fibroid removal) your risk is 6%
Of all uterine ruptures recorded in four studies:
Study one 42 ruptures 71% VBAC 29% in unscarred uterus(ref 5)
Study two 23 ruptures 43% VBAC 57% in unscarred uterus(ref 17)
Study three 480 ruptures 92% VBAC 7% in unscarred uterus 1% in non csec scarred uterus (ref 23)
Study four 81 ruptures 89% VBAC 11% in unscarred uterus(ref 27)
(These studies do not breakdown what types of scars the VBAC had and do not distinguish between ruptures and dehiscences).
It should be noted that in a number of the references there was no indication if the women who were recorded with ruptures had been in labour or not.
I could not find any studies in references that indicated a higher risk of rupture in women with macrosomic (large over 4kg) babies, twin pregnancies or breech deliveries. Ref 33 indicates there were no significant differences in death or injury in VBAC women with babies over 4kg, it also indicated of the recorded twin VBACs there were no ruptures and of the recorded breech there were no significant differences, however it indicated the preference was to do external version on breech babies. (Also a safe practice for VBAC mothers).
Can They Predict If I Will Rupture?
Ref 10 quotes a British study that involves measuring the thickness of the lower uterine segment by ultrasound late in the last trimester of pregnancy (over 35 wks). The study indicates that in women with the thickest lower uterine segments there is a very low chance of rupture. However the study also acknowledges that even for women with the thinnest lower uterine segments the risk of catastrophic rupture is still very small and can be offset with vigilant labour monitoring.
There are no major studies on the identification of a dehiscence however in this same study the sonographers believed they would be able to see dehiscence at the scar site using ultrasound. Given that dehiscence are considered benign I would wonder what the benefit of this would be as there are no studies that correlate the presence of dehiscence with a higher rupture rate, (mind you there are also none that disprove it either).

So how often do these things occur:
Study 1 9 ruptures 2 still born (22%)
(of the nine ruptures there were 2 classical csecs and 6 LSCS and one non scarred, the study does not say which of these mothers lost their babies)
0 hysterectomies and 0 maternal deaths (ref 7)
Study 2 155 ruptures 8 fetal deaths (5% - 5 occurred in mothers who arrived at hospital ruptured) 1 maternal death (doesn't indicate if this was a TOL or unscarred) (ref 10)
Study 3 17 ruptures 0 deaths 8 hysterectomies (ref 13)
Study 4 1 rupture 0 deaths (this rupture was in an elective repeat csec) (ref 14)
Study 5 23 ruptures 0 deaths (ref 18)
Study 6 13 ruptures 0 deaths (ref 20)
Study 7 8 ruptures 1 fetal death (12.5%) 2 severe fetal asphyxia (oxygen deprivation) 3 bladder lacerations 1 hysterectomy (ref 22)
Study 8 10 ruptures 2 fetal deaths (20%) (ref 26)
Study 9 81 ruptures 2 maternal deaths (2%) (these were a mix of scarred and unscarred uterus) 14 bladder injuries 12 hysterectomies 5 fetal deaths (6%) 14 neonatal deaths (17% - after birth deaths - the cause of these deaths is not given) 59 fetal brain damage (72% - the degree of damage is not indicated and it does not indicate if the 14 neonatal deaths are also included in this group) (ref 27)
If we add all of this up we have 317 reported ruptures, 30 (9.5%) fetal death rate, 3 (0.95%) maternal death rate and 61(19%) of babies with some degree of brain damage from oxygen deprivation (this may be minor or major).
To put this into perspective given that the VBAC mothers risk of rupture is around 1% , you have a (0.095%) chance of your baby dying due to rupture in any VBAC delivery, a 0.0095% of you dying due to rupture in any VBAC delivery and a 0.19% chance of your baby suffering brain damage due to a rupture in any VBAC delivery. (Contrast this to the other risk identified below).
The studies all indicated that one of the primary causes of death amongst mothers and infants was mismanagement by hospital staff. A number of the reports sited ignorance among staff of the symptoms of rupture and/or a slowness to act thus compromising both the mother and the child. The generally agreed treatment was that csec needed to be conducted within 30 mins of suspected rupture with some practitioners indicating this figure should be closer to 17 mins.

References
•Peripartum haemorrhage by Dr Sanjay Datta, MD, FFARCS
•Common Peripartum Emergencies by Dr Elizabeth Morrison American Family Physician Journal Nov 1 1998
•Once a CS always a Controversy by Dr B L Flamm ACOG Journal Vol 90 No2 Aug 97
•The Risks of Lowering the Caesarean Delivery Rate by Dr B Sachs MB, BS, DPH, Dr C Kobelin, MD, Dr Mary Ames Castro, MD and Dr Fredric Frigoletto, MD, The New England Journal of Medicine, 7 Jan 1999, Vol 340 No.1
•Induction of Labour and Uterine Rupture by Dr R Foon SHO, CESDI Steering Group 5th annual report 1997: 63-71
•Vaginal delivery after previous csec remain relatively safe by Dr Gregory and Dr L Korst, MD and Dr P Cane PhD Obstetrics and Gynaecology 94(6), Dec 99 pp 985-989
•Coombe Women's Hospital Obstetric Report 1998
•Genital Tract Trauma and Other Direct Deaths: Annual Report of The Maternal and Child Health Research Consortium London Jul 1998.
•Will VBAC become a way of the past OBCNEWS Issue 15.3, 13 Jul 1999
•ICAN /VBAC / Caesarean Webpage
•Recognising Problems in Labour by T. Stevens (Midwifery Research Practitioner)
•VBAC - Vaginal Birth After Caesarean or Very Big Authority Challenge? by B. Beech and P Thomas, AIMS Journal, Vol 8 No. 1 30 Apr 96
•Cases of Uterine Rupture and Subsequent Pregnancy Outcome by Al Sakka, Dauleh and Al Hassani of the Hamad Medical Corporation. International Journal of Fertility & Womens Medicine Nov-Dec 99.
•Delivery after Scarred Uterus at the University Hospital Centre of Dakar by Cisse, Ewagnignon, Terolbe and Diadhiou Journal de Gynecologie, Oct 99
•Vaginal Birth after Caesarean and Uterine Rupture Rates in California by Gregory, Korst, Cane, Platt and Kahn. Obstetrics & Gynochology Dec 99
•Intrapartum uterine rupture and dehiscence in patients with prior lower uterine segment vertical and transverse incisions by Shipp, Zelop, Repke, Cohen, Caughey and Lieberman. Obstetrics & Gynecology Nov 99.
•Rupture of the pregnant uterus a 21 year review - Sakka, Hamsho and Khan. International Journal of Gynaecology & Obstetrics Nov 98
•Vaginal Birth after Caesarean results in 310 pregnancies by Obara, Minakami, Koike, Takamizawa, Matsubara and Sato. Journal of Obstetrics & Gynaecology Research Apr 98.
•Intrapartum rupture of the unscarred uterus by ******, Goodwin, Gherman and Paul. Obstetrics and Gynecology May 97.
•Risk Factors Associated with Uterine Rupture during TOL after CSEC by Leung, Farmer, Leung, Medearis and Paul. American Journal of Obstetrics and Gyynecology May 93
•Rupture of low transverse csec scars duritng trial of labour. THe Journal of the American Medical Association 18 Sep 91
•Use of Hospital Discharge Data Monitor Uterine Rupture - Massachusetts 1990 - 97. Morbidity and Mortality Weekly Report 31 Mar 2000
•Use of Prostaglandins to induce labour in women with Csec scar by Vause and Macintosh. British Medical Journal Apr 17 1999.
•Csec Scar dehiscence following vaginal delivery by Connoly and Byrne. Journal of Obstetrics and Gynaecology Vol 19 No 6 1999
•Trial of Labour after Csec by McMahon, Luther, Bowes and Olshan. New England Journal of Medicine 1996.
•Catastrophic Uterine Rupture: Maternal and Fetal Characteristics by Kirkendall, Jauregui, Kim and Phelan. Obstetrics and Gynecology 2000
•Uterine Rupture: A placentally Mediated Event? by Jauregui, Kirkendall, Ahn and Phelan. Obstetrics and Gynecology 2000
•Uterine Rupture During a Failed Trial of Labor: Are There Any Identifiable Risk Factors in Labor Management by Burke, Lee, Harish, Sehdev and Ludmir. Obstetrics and Gynecology 2000
•Vaginal Birth After Prior Cesarean by Dr C Brittan. Jul 99.
•Delivery After Previous Csec: A Risk Evaluation by J Rageth. Obstetrics and Gynecology 1999.
•Medical Abortion Complications by D Nemec Obsterics and Gynecology Apr 78
•Cesarean Section: Guidelines for Appropriate Utilization by Dr B Flamm and Dr E Quilligan.
JanetF is offline  
#18 of 27 Old 08-29-2006, 03:19 AM
 
ckhagen's Avatar
 
Join Date: Sep 2004
Posts: 831
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
More anecdotal stuff...
My mom had a VBA3C and all three of her sections were classical incisions.
After her VBA3C, the birth climate started to change and she went on to have 2 more sections because she couldn't find anyone who would let her VBAC again. Silly huh?
ckhagen is offline  
#19 of 27 Old 08-29-2006, 03:23 AM
 
wifeandmom's Avatar
 
Join Date: Jun 2005
Posts: 1,539
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
All of this 'I know so-and-so who had a VBAC after however many classic incision c-sections' isn't truly relevant IMO.

I mean, really, didn't one of the Kennedy women have 11 c-sections and come out fine? Does that mean having 11 c-sections is even remotely a good idea? Ever?

Just because something 'can' be done, or 'has' been done by someone, somewhere in the world with no serious consequences doesn't mean it is or was the statistically safest decision to make at the time.
wifeandmom is offline  
#20 of 27 Old 08-29-2006, 10:25 AM
 
crunchymomof2's Avatar
 
Join Date: May 2005
Posts: 858
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Quote:
Originally Posted by wifeandmom
All of this 'I know so-and-so who had a VBAC after however many classic incision c-sections' isn't truly relevant IMO.
Just because something 'can' be done, or 'has' been done by someone, somewhere in the world with no serious consequences doesn't mean it is or was the statistically safest decision to make at the time.
No but sometimes it can be nice to know that other women have btdt and lived to tell about it.
crunchymomof2 is offline  
#21 of 27 Old 08-29-2006, 03:19 PM
 
kathan12904's Avatar
 
Join Date: Jun 2006
Location: The heart of progress in Missouri
Posts: 424
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
[QUOTE=wifeandmom]All of this 'I know so-and-so who had a VBAC after however many classic incision c-sections' isn't truly relevant IMO.
QUOTE]

Since the original poster asked for experiences and thoughts it seems like everything everyone has to say has relevence, not just what you deem relevant. And considering that study results are just a large collection of "i know so and so who had this experience" that would close out any sharing of information altogether. Whats the point of a discussion board anyway?

Mom of three spunktastic kiddos, supported by super-partner while dabbling in midwifery and organic farming. Biting off more than I can chew since '03.
kathan12904 is offline  
#22 of 27 Old 08-29-2006, 03:39 PM
 
wifeandmom's Avatar
 
Join Date: Jun 2005
Posts: 1,539
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Quote:
Originally Posted by crunchymomof2
No but sometimes it can be nice to know that other women have btdt and lived to tell about it.
I suppose, but it sure doesn't give me warm and fuzzy feelings that having 11 c-sections is even a remotely intelligent thing to do just knowing that Ethel Kennedy did it.
wifeandmom is offline  
#23 of 27 Old 08-29-2006, 03:47 PM
 
wifeandmom's Avatar
 
Join Date: Jun 2005
Posts: 1,539
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Quote:
Originally Posted by kathan12904
Quote:
Originally Posted by wifeandmom
All of this 'I know so-and-so who had a VBAC after however many classic incision c-sections' isn't truly relevant IMO.
Since the original poster asked for experiences and thoughts it seems like everything everyone has to say has relevence, not just what you deem relevant. And considering that study results are just a large collection of "i know so and so who had this experience" that would close out any sharing of information altogether. Whats the point of a discussion board anyway?
Surely you see the difference between 'I know so and so' and a true research study?? :

Study results are controlled for so many variables that your statement of them being 'just a large collection of I know so and so' is actually kind of funny.

My point was just because someone, somewhere, at some point in history, has successfully done something, that doesn't make it the wisest or safest choice.

My parents didn't buckle us in car seats. It just wasn't something people did routinely 30 years ago. We know better now, therefore it IS routine to use car seats. So if I came on here with my past experiences of 'being just fine' without riding in a car seat and said I wasn't going to use them myself, my past experience of being 'just fine' really isn't the point. Does that make sense?

You have to look at the big picture, and the big picture tells us that it is NOT a good idea to ride around with unrestrained children, DESPITE the fact that many of us posting here this very day were unrestrained as children. We're all alive, so it must be safe enough...right?

Do you see how that doesn't make good sense?
wifeandmom is offline  
#24 of 27 Old 08-29-2006, 03:56 PM
 
kathan12904's Avatar
 
Join Date: Jun 2006
Location: The heart of progress in Missouri
Posts: 424
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I guess I'm suprised that it would be taken for granted that every single research study is highly scrutinized and that some are not biased toward the pov of the group or organization running it. The point I'm trying to make is that this is a discussion board and that is exactly what is going on, discussion. If this was a fact finding commitee or research group, then I suppose only documented statistics should be allowed in, but keeping in mind that most women come here looking for community and advice, I consider it grossly inappropriate to belittle those who don't agree with you or your information be negating their experiences or derived knowledge. Since I can see that this is no longer about helping counsel a woman and gathering diversified input and has become about someone needing to be absolutely right and have the last word, this is the last I will be saying about it. Good luck wish2b.

Mom of three spunktastic kiddos, supported by super-partner while dabbling in midwifery and organic farming. Biting off more than I can chew since '03.
kathan12904 is offline  
#25 of 27 Old 09-04-2006, 01:48 AM
 
mom2isaiah's Avatar
 
Join Date: Sep 2006
Posts: 2
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I cannot believe I found real people talking about this!!!

I need to hijack a minute, if I might.


I had my son prematurly. I had a c-section, and ended with an inverse T incision. He was 1# 5oz and I'm assuming they cut across and up my whole uterus to get him out as it was thick and small. My water broke at 22 weeks and he was born at 28.

Ok-so, I'm 25 weeks pg with #2 and my doc is insisting b/c I have a classical incision, I have to deliver at 36 weeks I DO NOT WANT TO. I've tried desperately to find research, and found some that was quoted previously on this thread-but none that states that subsequent pg after classical incision should be delivered early. I'd be happy with 37 weeks-but doc worries about rupture.

Can anyone help me out? I got a positive pg test 3 days after my son's second birthday, so we waited a full 2 years before conceiving, giving my uterus enough time to heal.

TIA!
mom2isaiah is offline  
#26 of 27 Old 09-04-2006, 05:18 AM
 
majikfaerie's Avatar
 
Join Date: Jul 2006
Location: State of Confusion
Posts: 20,453
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
mom2isiah,
sorry to hear you're having a rough time.
I havent found any evidence to suggest delivering at 36 weeks to be a lower risk than the potential damage to the baby being born premature.
Basically, you have a small but real risk of rupture, against the very real (and deliberate) problems a baby faces when being delivered 4 weeks early.
I think the reason you cant find research to support your OB's claims is that the research *doesnt*.

first thing, go and get a second opinon from an OB that is very pro-VBAC and non-intervention. get as many "second" opinions as you like, and try insisting on a trial of labour.

even with a T incision, the risk of rupture is still quite low. (though not without consideration), but the risks of a preeemie baby are certain.

By reading this signature, you agree to join my cult :nana
Google me, you know you want to mischievous.gif
majikfaerie is offline  
#27 of 27 Old 09-04-2006, 08:15 PM
 
TurboClaudia's Avatar
 
Join Date: Nov 2003
Location: in a yellow house
Posts: 7,363
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
sure, there is a difference between "i know so-and-so and they did it and they are fine" and research studies, but a previous poster is correct when they say that knowing someone else and their baby were healthy and succesful at accomplishing a vbac with a classical incision on the uterus speaks to a different place.

also, there is a huge difference in being uncomfortably coerced into a decision by scare tactics and statistics and numbers that may be irrelevant and making a choice based on information and also on your particular situation. coercion and choice-making are vastly different.

~claudia
TurboClaudia is offline  
Reply

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the Mothering Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
If you do not want to register, fill this field only and the name will be used as user name for your post.
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



User Tag List

Thread Tools
Show Printable Version Show Printable Version
Email this Page Email this Page


Forum Jump: 

Posting Rules  
You may post new threads
You may post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are Off