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Discussion Starter · #1 ·
X-Posting this in birth professionals<br><br>
I'm having trouble. I'm 5 weeks pregnant and in pursuit of a birth attendant. Midwives cannot legally attend VBACs in my state, so every licensed midwife I've spoken with won't take me outright.<br><br>
Now, I spoke to an unlicensed midwife yesterday and she is insistant upon knowing what type of closure I had done at my c-section. I called my former OB and asked this question already and her nurse told me that her standard is a single layer closure. This midwife won't take me if I only had a single layer closure. (I am in the process of getting my medical records to know for sure what was done on me.)<br><br>
I feel really betrayed by my OB. She told me at a consult a few weeks ago (before I knew I was pregnant) that "vaginal birth is really overrated" and "you won't care in 30 years if you only had c-sections," so somehow I doubt she sewed me up with a double layer in preperation for a VBAC.<br><br>
Also, upon doing some research last night, it seems like a single layer has been the standard for some time. Yes, the ruputre rate is a bit higher, but not anything to be crazy worried about, IMO.<br><br>
I completely understand and respect this midwife and the fact that she has to feel comfortable with what she's getting into. I certainly don't want her to take me if she doesn't. But this entire issue leaves me feeling like I have my back against a wall, you know? So frustrating.<br><br>
So, with all that long rambly stuff out, what was your closure and where did you birth?
 

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I have a single layer closure and vbac’d with a midwife in a hospital since it’s illegal for midwives to attend hbacs around here. FWIW, I labored for nearly a week off and on. By the time my dd was born, I had labored for 41 hours straight.<br><br>
The midwife you spoke to is probably taking the recommendations of Ina May Gaskin. While I know Ina May is wonderful, she has this odd “thing” about single layer closures. I understand that’s been the norm in Europe for years and they don’t have higher rates of rupture.<br><br>
You can request a copy of your surgical report from your ob to check our your suturing. Legally, they must give it to you. It’s only a 1 or 2 page report.<br><br>
My midwives warned me that their back up doctor doesn’t care for single layer sutures and would want me to have an IV and CFM. Luckily, the hospital offered wireless monitoring but I told them as hep-lock was as far as I would go. So I went crazy reading everything I could about single vs double layer suturing. There are certainly issue with the studies claiming single layer sutures are at higher risk of rupture (for instance, most women had sutures made of chromic catgut which is not as strong as the more commonly used Vicryl).<br><br><a href="http://romancathanachronism.typepad.com/ican_somerset/2007/09/single-vs-doubl.html" target="_blank">Here</a> are studies showing lower rates of rupture with double layer sutures<br><br><a href="http://romancathanachronism.typepad.com/ican_somerset/2007/09/single-vs-dou-1.html" target="_blank">Here</a> are studies showing no different in rates of rupture based on single or double layer sutures.<br><br>
In “defense” of your ob, I believe the 16th edition of Williams Obstetrics recommends a single layer suture so many obs follow that. In addition, you are open for less time and single layer sutures tend to heal better.
 

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I VBACed with a single layer closure in December. I used a pro-VBAC OB who wasn't concerned with the single layer at all. His opinion was that he had seen no difference with single/double layer closure and he has done a lot of VBACs, (he is the only OB in the area that will do them).
 

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I have had 2 VBACs w/ a single layer closure. I VBACed w/ the same OB who did my c/s and he suggested a VBAC before I did so he obviously sees nothing wrong w/ a single layer closure.
 

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In Europe they use mostly Single layer and they VBAC over there.<br><br>
I have read that is no real difference. Get your records to be sure.
 

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I have vbac'd twice with single-layer closure in a hospital. OB had no problems with this. The study about the increased rupture rates is misleading IMHO b/c it does not take into account if the labors were induced or augmented -i.e cervadil, cytotec, pitocin etc.
 

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I had an HBAC after a c/s with a single layer closure. My midwife and doctor and I all agreed that the research was mixed regarding closures and that since I was okay with the risks and benefits of HBAC then that's what I should aim for. My midwife did suggest an ultrasound to confirm that my placenta was nowhere near my scar, so she wouldn't worry about placenta acreta. When I was in labour nobody even mentioned rupture, I don't think anybody was really worried about it. I really love my birth team for their respectfulness.
 

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I had an awesome HBAC after a single layer closure. My mw wanted to know, but the med rcds didn't specify. She recommended I asked the OB what her standard was at the time. The nurse called me back and said "single".<br><br>
I was freaking out and crying ...but came on here to hear about other's experiences. I'm sure you can find my upset post about it! Search here for other posts about it too, reading other women's experiences calmed me a lot. My MW wasn't concerned and still trusted me and my body.
 

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Discussion Starter · #9 ·
Thanks for all the stories and research. This is so frustrating to me! I'm having a really hard time finding an OB who even does VBACS. I don't like feeling like I have to beg.
 

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I think I have single and HBACed in 07. I say "I think" because 2 midwives (one CPM and one CNM) told me it was probably double, but it looks like more of a single to me after hearing others medical reports. It says one layer of interlocking sutures with some other type of suture to control bleeding. Both told me it didn't really matter one way or the other and that "a good scar is a good scar".<br><br>
I will also say I was a doula once for a woman who ended up having a c-section and before the section I asked the resident myself what her standard closure was. She said single. I mentioned the fact that this woman (very obviously) wanted to have a VBAC next time and the resident said that the literature tells of no difference between single and double layer closures and rupture rates. She was in a hurry (and was kind of brusk) so I didn't press her further.<br><br>
I wouldn't worry about it.
 

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Perfect hbac with single layer suture on 03/08. The argument about this is rampant although there isn't any evidence to support single layers being more dangerous. Ina May's stance probably is scaring this unlicensed midwife since she has so much to worry about for liability. Frankly, learning about Ina May's uneducated stance on this made me realize that she is restricting her clientel to make her stats better and while the Farm's success has brought more info about hb to many people, they're really hurting vbacers. I wish that such a smart and talented midwife would keep herself updated on single layer closure's safety so that women like you and I didn't have to deal with the proliferated misconception.
 

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I've read conflicting studies. It still has been something on my mind and something that I have taken into consideration when debating whether or not I wanted to attempt VBACC. My closure is a triple-layer but my incision is a classical. It gave me a little reassurance, even if it is artificial. At this point, my biggest fear is placenta attachment. Studies have been pretty conclusive that if the placenta implants over the scar then the rupture rate rises quite a bit. Enough to make me just go for an RCS.
 

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Discussion Starter · #13 ·
I'll have a 2nd tri u/s to check placenta placement and the baby's condition. I sure don't want any surprises.<br><br>
And, drum roll please, I found a midwife! She is unlicensed, but said the closure was no issue to her as long as I had a transverse incision. She's even done several VBACs on classical incisions without incident. I feel confident at this point. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/orngbiggrin.gif" style="border:0px solid;" title="orange big grin">
 

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<div style="font-style:italic;">And, drum roll please, I found a midwife! She is unlicensed, but said the closure was no issue to her as long as I had a transverse incision. She's even done several VBACs on classical incisions without incident. I feel confident at this point. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/orngbiggrin.gif" style="border:0px solid;" title="orange big grin"></div>
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That's excellent news! Congratulations!
 
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