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Discussion Starter · #1 ·
Would you assist a woman in a VBAC after an Inv T, J or classical cesarean? Why or why not? Feel free to respond privately. I want to understand the fears that are out there.
 

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We've done births for moms who've had a classical incision. Personally, I would want mom to get an u/s to see where the placenta is. If it's over the scar tissue, you could have placenta accreta and wouldn't want to deal with that at home.
 

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Discussion Starter · #3 ·
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Originally Posted by 636Jen View Post
We've done births for moms who've had a classical incision. Personally, I would want mom to get an u/s to see where the placenta is. If it's over the scar tissue, you could have placenta accreta and wouldn't want to deal with that at home.
Right. I totally get that. Would you recommend that the woman attempt labor in a hospital? Do you have VBAC friendly OBs that you recommend in these cases?

However, I would like to point out that I had an anterior placenta with an inverted T scar for my VBAC in a birth center with a hb midwife. lol I think it ended up high, but the vertical portion of my scar was 8 cm long. *shrugs* All was well, but my placenta came out in pieces for whatever reason, no excessive bleeding. I did not smoke during my pregnancy nor was I exposed to smoke. *shrugs* Too early in my studies for me to be able to figure out what caused it and my midwife didn't have any thoughts either. This time it's totally posterior though.
 

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I wouldn't paint all VBACs with the same brush. I would take it on a case by case basis. Your history is important and I would take that into consideration so I wouldn't completely dismiss a homebirth. I would love to hear from the more experienced midwives out there though!
 

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Discussion Starter · #5 ·
Quote:

Originally Posted by 636Jen View Post
I wouldn't paint all VBACs with the same brush. I would take it on a case by case basis. Your history is important and I would take that into consideration so I wouldn't completely dismiss a homebirth. I would love to hear from the more experienced midwives out there though!
Right, I also forgot to mention that my scar was 7 yrs old when I VBAC'd. lol

I am curious what thought trees experienced midwives use, how different they are from the one that my midwife used.
 

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so true classical incision has a pretty high rate of rupture/dehiscence- some reports say as high as 19% ,my guess is the rate is closer to 12% but that is still a high rate of rupture , throw into that mix a higher rate / chance of abnormal placentation, reported higher rates of preterm labor... - I know a doc or 2 who will give select moms a chance at VBAC and that is most likely the best place for those moms- another factor to consider is interpregnancy spacing- no closer than 18-24 months...
 

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Discussion Starter · #7 ·
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Originally Posted by mwherbs View Post
so true classical incision has a pretty high rate of rupture/dehiscence- some reports say as high as 19% ,my guess is the rate is closer to 12% but that is still a high rate of rupture
Actually, the Landon Study found a rupture rate of 1.9% for Inv T, J, and classicals together. The sample size was very small only 105, but there was a larger group (a little over 3,200) that had unknown scar types that only had a 0.5% risk of rupture. I'd be willing to bet that some of those unknowns were Inv T, J or classicals as well.
 

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I thought that the lower incisions were basically on a par with low transverse- and because I know a mom who had a rupture/dehisence of a low transverse- that was not detected until a day after because it happened during pushing- well ultimately she was fine and the baby was born fine- but all the flow that should have been coming out was going into her peritoneal cavity- made her sick- it was a quite large dehisence but did not extend to her arteries but basically the full scar seperated- I also know of a uterine rupture in a primip who had fibroids- so I will not only place emphasis on c-sections other than to be a be more knowingly concious of dehisences as much more of a health hazard than portrayed - it is one thing for medical people to blow off stats like that because they are instantly checking and quick to physically explore and to cover with antibiotics- and because they end up with more infections in general it doesn't seem out of the average- but we don't have these things simply available to us. so yes I would attend a low t like a low transverse cut but would want 2 year child spacing and to know where the placenta is located- I don't really care if a placenta comes out in 15 minutes or 24 hrs if there is no detachment or bleeding- it is the partly detached placenta that is the huge problem that I cannot easily remedy at home. and I will not "cherry pick" the stats for the lowest- the older studies are the ones that really talk about classical incisions and rupture rates and I am sure that maternal mortality and morbidity from classical incisions were the reason they changed from that practice for the most part. Many people will quote for classical a 9% true rupture rate and leave off the dehisence rates.
 

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Discussion Starter · #9 ·
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Originally Posted by mwherbs View Post
I thought that the lower incisions were basically on a par with low transverse
I just read a study yesterday that found VBACs after low vertical incisions to have no more risk than a VBAC after a low transverse incisions. I can find it if you want.

Quote:

Originally Posted by mwherbs View Post
- and because I know a mom who had a rupture/dehisence of a low transverse- that was not detected until a day after because it happened during pushing- well ultimately she was fine and the baby was born fine- but all the flow that should have been coming out was going into her peritoneal cavity- made her sick- it was a quite large dehisence but did not extend to her arteries but basically the full scar seperated- I also know of a uterine rupture in a primip who had fibroids- so I will not only place emphasis on c-sections other than to be a be more knowingly concious of dehisences as much more of a health hazard than portrayed - it is one thing for medical people to blow off stats like that because they are instantly checking and quick to physically explore and to cover with antibiotics- and because they end up with more infections in general it doesn't seem out of the average- but we don't have these things simply available to us. so yes I would attend a low t like a low transverse cut but would want 2 year child spacing and to know where the placenta is located- I don't really care if a placenta comes out in 15 minutes or 24 hrs if there is no detachment or bleeding- it is the partly detached placenta that is the huge problem that I cannot easily remedy at home. and I will not "cherry pick" the stats for the lowest- the older studies are the ones that really talk about classical incisions and rupture rates and I am sure that maternal mortality and morbidity from classical incisions were the reason they changed from that practice for the most part. Many people will quote for classical a 9% true rupture rate and leave off the dehisence rates.
Most of all that makes sense. I haven't been able to find any studies that quote dehisence rates related to Inverted Ts, haven't looked specifically for classicals though. I do know that fibroids and adhesions can affect the outcome of a VBAC attempt as well.
 
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