[sailorsimba]

T and J incisions are typically lumped together and it is said to carry a 4-9% risk of rupture. Does that include T and J incisions that go both up and down? I have a J incision and I am seriously terrified of having another c-section.

My first one was a nightmare that had me in the ER twice and back to the hospital twice a day for gauze changes for the first week. DH took over that lovely job after he got comfortable seeing them do it.

Can someone please tell me that a VBAC is worth going for? Everyone but me seems to think I should just schedule the surgery.

 

[CalliesMomma]

I have a classical incision and it's generally studied with the same groups as T and J incisions. You're right, ACOG cites 4%-9% rupture rates with these types of incisions, but the studies that I've found don't have rupture rates anywhere close to that. The studies that I've found generally have a rupture rate of about 1%-2%. It's still high, but the problem is that women that have these types of incisions don't generally VBAC so it's hard to get a good solid statistic and the stats that are out there don't account for different variables like the low-transverse studies do. I have even read the study that ACOG derives their stats from and it's so far skewed and so heavily biased (the author, Dewhurst, was a known opponent of VBAC and opinions show through in his findings). It also happens to be the only study out there that has found classical rupture rates that high. Now, I'm not advocating that everyone out there with a classical, T, or J incision should have a VBAC. It all depends on your personal comfort level. Even though the rupture rates are really about 1%-2%, the ruptures that do occur tend to be catastrophic ruptures rather than just mild dehiscences. For me, personally, VBACC is the way to go. I will be in a very high-tech hospital that is fully capable of attaining a decision to delivery time of under 10 minutes. They achieved this with my first, which was a crash situation and I'm completely confident that they can handle this again. They have round-the-clock, in-house anesthesia and surgeons and one of the most advanced neonatals teams out there. Most of the women on here seem to prefer home-birth, but for me and my situation, this is the way to go and every woman should birth where they feel most comfortable. I feel most comfortable at the hospital that is best equipped to handle a catastrophic rupture. Also, it's going to be very difficult to find a provider. I first tried a group of hospital-based midwives and they turned me away, but they referred me to the OB that oversees their practice. Before I went into my appointment with him, I called every homebirth midwife I could find and none of them would take me on. When I went into my OB consultation, I was surprised to find that he was perfectly ok with my VBACC plans. Up until that point I truly thought that the only way I would be able to have my VBACC would be to birth at home or to go into the hospital in labor and fight for it. It took me just over a month to finally settle with my OB and I was getting very discouraged and depressed up until that point. Just be ready for the long-haul....it might take some time to find someone willing to support you.

Here is some more information on rupture rates:
http://www.emedicine.com/med/topic3746.htm

I also have a wonderful excerpt from the Australia/New Zealand Journal of Obstetrics and Gynecology that deals strictly with these types of incisions. It's in PDF format, though. If you would like a copy of it, pm me your e-mail address and I'll be happy to send it to you! Good luck!

Amanda

 

[elphalba]

You will have a harder time finding a provider willing to do a VBAC BUT I can't ever see a c/s as preferable over natural birth. I had a textbook c/s and I would still sell my left arm not to have one again.

 

[sailorsimba]

Quote:

Originally Posted by elphalba You will have a harder time finding a provider willing to do a VBAC BUT I can't ever see a c/s as preferable over natural birth. I had a textbook c/s and I would still sell my left arm not to have one again.

It makes me happy to not be the only one who feels like this.

The doc is saying that the incision goes across an artery and I could lose a massive amount of blood if it ruptures. I am curious though to find out how the incision goes over that artery without me having massive blood loss the first time, KWIM?

 

[barefootpoetry]

Quote:

Originally Posted by sailorsimba The doc is saying that the incision goes across an artery and I could lose a massive amount of blood if it ruptures. I am curious though to find out how the incision goes over that artery without me having massive blood loss the first time, KWIM?

I am in the same boat as you. I have an unusual incision that puts me more in the class of T and J rather than the usual low transverse, and it does sit right on a major artery. It split 1 week PP and because it was right on that stupid artery I nearly hemorraged to death.

I am having a homebirth, and although my MWs are a little nervous about this unusual situation, they agree that a safe, healthy VBAC would be better than a ERCS. They are not advocating that. The CNMs I am seeing for tandem care, however, are not advocating a VBAC at all. Different perspectives I suppose.

 

[sailorsimba]

It's nice to know that someone else is in the same boat. So far no one seems to know what I am talking about and all the research I can find barely even mentions it.

 

[dinahx]

How did y'all wind up with these unusual incisions??? Is it just up to the doctor?

 

[rachaelmomma]

good for you for considering a VBAC! ICAN has a white paper on both the inverted T and the J incision types I believe. I know of many women on the ICAN mailing list who have had a successful VBAC after such types of incisions. There are several websites out there with studies and numbers. I believe that plus-sized pregnancy.org has some info there on the website as well. http://www.plus-size-pregnancy.org/firstindex.html I highly suggest you find your nearest ICAN chapter, and ask around. See who is willing to provide care, who you might should avoid, and seek the support of women who are going or have gone through the same stuff as you. Good luck!

 

[sailorsimba]

Quote:

Originally Posted by dinahx How did y'all wind up with these unusual incisions??? Is it just up to the doctor?

Mine was a tear. DS was extremely low by the time I was exhausted so they really had to pull and tug to dislodge him.
He does note in the post op report that he marked the apex of the tear and made sure to double suture the entire thing.

 

[Mrs-Mama]

Quote:

Originally Posted by dinahx How did y'all wind up with these unusual incisions??? Is it just up to the doctor?

I have a J-incision b/c the OB attempted a low transverse incision with 32-week DS who was wedged diagonally in my uterus with his head in my ribs. His body came out, but his head got stuck so he had no choice but to go up. Vertical incisions are more common with preemie c/s deliveries because the lower part of the uterus to small to make a big enough incision to deliver the baby

:

 

[CalliesMomma]

I'm not entirely sure the reasoning behind my classical, but from my own research I can speculate. I've read that preemies are delivered by classical more often because prior to 34 weeks, the lower segment of the uterus isn't formed yet. Callie was a 28 weeker. BUT, she was also breech and when they actually did the surgery, she had one foot in and one foot out. I think that could also have played a part in it. My surgery was basically one of the statistical anomalies. I also had general anesthesia, which is rare.

 

[Norasmomma]

I have a T incision, mine is because my DD was wedged into my pelvis after 3 hours of pushing, but she wouldn't descend and was very stuck. They literally had to push her back up and out. I also think that she was so stuck because she was a little sideways in my pelvis, my water was already broken, but it sprang a leak at the top. When it was fully broken I swear I felt her shift even more sideways than she already was(I am almost positive she was already facing weirdly to the left because the last month of my pregnancy I could barely walk it hurt so frickin bad).

So I have a pretty big T-incision, the Dr who preformed it came in the day after and was pretty serious that it was not the norm. The hospital routinely has performed VBAC, but he told me I was a really bad candidate, and repeatedly told me that.

 

[barefootpoetry]

I have a low transverse on the outside, but the incision inside extends way down into my vaginal wall and cervix. DS's head was so firmly engaged in my pelvis that they had to rip really far down to get him out. The artery that caused all the trouble is on my cervix. Because this is unusual, it puts me in the category of T or J according to a number of midwives including my own. And if it wasn't for them I never would have learned about this...no one ever told me about this strange incision/tear until my MWs were looking at my surgical report and scratching their heads going "how did your cervix tear if you never pushed a baby out?"

 

[sailorsimba]

Quote:

Originally Posted by barefootpoetry I have a low transverse on the outside, but the incision inside extends way down into my vaginal wall and cervix. DS's head was so firmly engaged in my pelvis that they had to rip really far down to get him out. The artery that caused all the trouble is on my cervix. Because this is unusual, it puts me in the category of T or J according to a number of midwives including my own. And if it wasn't for them I never would have learned about this...no one ever told me about this strange incision/tear until my MWs were looking at my surgical report and scratching their heads going "how did your cervix tear if you never pushed a baby out?"

You're tear is just like mine and it takes a lot of weight off my shoulders knowing that your MW is willing to agree to an HBAC. I told my DH about the studies I saw from this thread and he seemed to agree with me that the tear raised my risk but not a lot which I am ok with.

 

[barefootpoetry]

Quote:

Originally Posted by sailorsimba You're tear is just like mine and it takes a lot of weight off my shoulders knowing that your MW is willing to agree to an HBAC. I told my DH about the studies I saw from this thread and he seemed to agree with me that the tear raised my risk but not a lot which I am ok with.

It does make the both of us slightly higher risk, but my MWs agree that an HBAC, or at the very least a hospital VBAC, would be better than ERCS. They are more stringent on how things would have to unfold and they'd be more eager to transport at the first sign of trouble due to this, but they are not shutting me out entirely, which means the world to me. They've consulted many of their peers and while some say no way, most of them say go for it - just be careful!

We all have high hopes...and if things don't pan out, we will be literally blocks away from the hospital.

 

[sailorsimba]

I talked to my doc again today. He didn't even mention the risk and the emergency C/S response time. He says he thinks I am crazy to go through labor again and take any risk when the baby "won't fit." That makes a lot more sense to me. DS would have fit if I hadn't been exhausted from 4 and a half hours of pushing but I'll let him have his opinion (I know my body can do it) and I'll go about my VBAC plans like I had been.
Silly OBs....