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Discussion Starter · #1 ·
My Cousin-in-law's wife is pregnant with her second baby and due in May. Her first was just born in March so they will be 14 months apart. Her first was a c/s. I don't know her very well (met her two or three times, family dinners only) but we'll be seeing her at Christmas and I really want to approach the subject of vbac with her, but I don't know how. I don't even know if I should. I've read some statistics that don't recommend vbac for births less then 18 months apart.<br><br>
If I do approach the subject, I think I'll as her If I could e-mail her a few things. I've gathered some great stats from you all here before my vbac but havn't read much on the risks of vbac in births less than 18 months apart (mine was 22 months).<br><br>
Any suggestions would be greatly appreciated. Also, my husband LOVES to talk about my vbac. He could use a few suggestions on how to talk to her hubby as well (more along the lines of what not to say for him though<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/lol.gif" style="border:0px solid;" title="lol">)
 

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I dont have any stats for you but my first VBAC was just 14 months after my c-section. I have had 4 more since then.
 

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I would get a full copy of these articles, which are the best stats I can find on the issue (references and abstracts below), so that she can make an informed decision:<br><br>
Bujold E, Mehta SH, Bujold C, Gauthier RJ.<br>
Interdelivery interval and uterine rupture.<br>
Am J Obstet Gynecol. 2002 Nov;187(5):1199-202<br><br>
Abstract: OBJECTIVE: The purpose of this study was to measure the impact of the interdelivery interval on uterine rupture during subsequent delivery. STUDY DESIGN: An observational cohort study was performed to assess the rate of uterine rupture in women with a previous low transverse cesarean delivery and no previous vaginal delivery who undergo a trial of labor from 1988 to 2000 in a tertiary care center. The rate of uterine rupture was measured for each of the following interdelivery intervals: <or=12 months of gestation, 13 to 24 months of gestation, 25 to 36 months of gestation, and >36 months of gestation. Multivariate logistic regression analysis was used to adjust for selected confounding variables. RESULTS: Of the 1527 women who met the study criteria, the rate of uterine rupture was 4.8% for patients with an interdelivery interval of <or=12 months of gestation, 2.7 % for patients with an interval between 13 and 24 months of gestation, 0.9% for patients with an interval between 25 and 36 months of gestation, and 0.9% for patients with an interval of >36 months of gestation (P =.04). After adjustment for the confounding variables, the odds ratio for uterine rupture in women with an interdelivery interval of <or=24 months of gestation was 2.65 (95% CI, 1.08-6.46) and 4.33 (95% CI, 1.70-10.98) in women with a single-layer closure of the previous uterine incision. The combination of an interdelivery interval of <or=24 months of gestation and a single-layer closure of the previous uterine incision were associated with a rate of uterine rupture of 5.6%. CONCLUSION: An interdelivery interval of <or=24 months of gestation was associated with a 2- to 3-fold increase in the risk of uterine rupture compared with an interval of >24 months of gestation.<br><br><br>
Huang WH, Nakashima DK, Rumney PJ, Keegan KA Jr, Chan K.<br>
Interdelivery interval and the success of vaginal birth after cesarean delivery.<br>
Obstet Gynecol. 2002 Jan;99(1):41-4.<br><br>
Abstract: OBJECTIVE: To determine whether a short interdelivery interval is associated with decreased rate of successful vaginal birth after cesarean (VBAC). METHODS: A retrospective cohort study from January 1, 1997, to December 31, 2000, was conducted. Patients with previous cesarean delivery who attempted VBAC were identified. The analysis was limited to patients at term with one prior cesarean. The interdelivery interval was calculated in months between the index pregnancy and prior cesarean delivery. RESULTS: A total of 1516 subjects who attempted VBAC were identified among 24,162 deliveries, with complete data available in 1185 cases. The VBAC success rate was 79.0% for patients with an interdelivery interval less than 19 months compared with 85.5% for patients with an interval delivery greater than or equal to 19 months (P =.12). For patients whose labors were induced, interdelivery intervals of less than 19 months were associated with a decreased rate of VBAC success when compared with longer intervals (P <.01). Sufficient power (beta =.95) existed to detect a 64% difference between the groups (alpha =.05). No significant difference was detected in women who underwent spontaneous labor (P =.98). There was no difference in the rate of symptomatic uterine rupture (P = 1.00). CONCLUSION: Interdelivery intervals of less than 19 months were associated with a decreased rate of VBAC success in patients who underwent induction, a difference not found in those with spontaneous labor.
 

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I'll see what I can find...I used to have the site bookmarked but a new computer means no old bookmarks!<br><br>
What my wonderful amazing 110% pro-vbac obs said was at least 12 months between the c/s and the next pregnancy or roughly 24 months between the c/s surgery and the next birth. But there are certainly plenty of mamas here who have vbac'd with less time between births.<br><br>
Hmmmm... here's one (<a href="http://www.emedicine.com/med/topic3434.htm" target="_blank">http://www.emedicine.com/med/topic3434.htm</a>)
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Interpregnancy interval<br><br>
The timing between pregnancies has recently become an interesting predictor for a number of obstetric outcomes, VBAC success among them. In one analysis, women who had an interpregnancy interval of more than 18 months had an 86% chance of VBAC success, while women whose interpregnancy interval was less than 18 months had a VBAC success rate of 79%. This difference was not statistically significant, and whether interpregnancy interval does have any effect on success or rather has an effect on the risk for uterine rupture is unclear.</td>
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And on pubmed I just found a brand spankin' new study that says the risks of vbac are greatly increased when the interpregnancy interval is short...but they found the real increase of risk was an interval of 6 months or less and the more than 6/less than 12 wasn't as high risk. (Short interpregnancy interval: risk of uterine rupture and complications of vaginal birth after cesarean delivery. Obstet Gynecol. 2007 Nov;110(5):1075-82)
 

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Discussion Starter · #5 ·
Thank you all so much for your responses! I'm bookmarking now
 

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18 months seems to be industry standard, but I also think that it is a knee-jerk response form most docs and midwives. Even my midwife was required to inform me that VBAC's are not recommended for < 18 months blah blah blah but then when I said, I'm still most interested in trying to vbac and my girls were born (vbac!) 18 months + 1week.<br><br>
I kind of think that 18 months is a bit of an arbitrary number.
 

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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>misseks</strong> <a href="/community/forum/post/9948312"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">18 months seems to be industry standard, but I also think that it is a knee-jerk response form most docs and midwives. Even my midwife was required to inform me that VBAC's are not recommended for < 18 months blah blah blah but then when I said, I'm still most interested in trying to vbac and my girls were born (vbac!) 18 months + 1week.<br><br>
I kind of think that 18 months is a bit of an arbitrary number.</div>
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Did you read the studies posted above? 18 months actually is on the short side according to some studies. 24 months or more is associated with the lowest rupture risk. Anything less than 24 months carries a greater risk. That's *not* to say it's TOO risky, just MORE risky than the standard 0.5% risk typically accepted for VBACs in general.<br><br>
From above:<br><br><div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Of the 1527 women who met the study criteria, the rate of uterine rupture was 4.8% for patients with an interdelivery interval of <or=12 months of gestation, 2.7 % for patients with an interval between 13 and 24 months of gestation, 0.9% for patients with an interval between 25 and 36 months of gestation, and 0.9% for patients with an interval of >36 months of gestation (P =.04). After adjustment for the confounding variables, the odds ratio for uterine rupture in women with an interdelivery interval of <or=24 months of gestation was 2.65 (95% CI, 1.08-6.46) and 4.33 (95% CI, 1.70-10.98) in women with a single-layer closure of the previous uterine incision. The combination of an interdelivery interval of <or=24 months of gestation and a single-layer closure of the previous uterine incision were associated with a rate of uterine rupture of 5.6%</td>
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This particular study showed a risk of nearly 5% UR risk with 12 months between deliveries, 2.7% with 13-24 months between deliveries, and only at 24 months does the risk dip below 1% (even then, it's still 0.9% in this study).<br><br>
It also seems this study addressed the issue of single layer vs. double layer suturing. Combining single layer closure with delivery less than 24 months after the c-section gave a rupture rate of 5.6%.<br><br>
Docs and midwives aren't pulling this 18 months apart stuff from their behind. There is actual research to support it.
 

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I vbac-ed and my 1st 2 were 19 months apart. That said. That's almost a full 6 months longer than 14 months. That's really close, and doesn't really leave the uterus a lot of time to recover.
 

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Mine will be between 16-17 months apart, I'll let you know how it goes <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"><br><br>
As for the studies, I would be curious to see not just the increase risk in attempted VBAC, but compare that to the % of complications from repeat c/s under 18 months. There may not be a large difference between the two, then again there may be, I dunno, just think you should look at every angle.<br><br>
Also the study says induction is the key ingredient. Without induction her risks are no higher than 18+ monthers.
 

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<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>OceansEve</strong> <a href="/community/forum/post/9951187"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
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Also the study says induction is the key ingredient. Without induction her risks are no higher than 18+ monthers.</div>
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I didn't see it say that. Not saying it wasn't there, but can you point it out?<br><br>
The only thing I saw was where it compared spontaneous vs. induced labor in both groups (closely spaced vs. 18+ months) for actual VBAC success rates.<br><br>
Induction very clearly increases rupture rates according to most published research. Closely spaced pg, induced or not, *also* increases rupture rates. It would stand to reason then that inducing a closely spaced VBAC attempt would be worse than either circumstance alone, however merely avoiding induction in closely spaced pg isn't going to negate the fact that just being too close together increases the risks of UR.<br><br>
It seems from current research that the 'ideal' VBAC attempt is at least 24 months after the initial c-section AND is spontanous labor without augmentation of any kind during labor. I think having a previous vaginal birth and/or not-likely-to-recur circumstances for the first section are also positive predictors of VBAC success. I'd also be willing to bet that where you attempt a VBAC and with what type of provider you are under the care of have a huge impact on success rates, though I'd bet neither have much to do with actual rupture rates.
 

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My boys are 17 months apart, and the youngest was a VBAC. I don't have the links or studies, but I do remember reading that my risk was closer to 2% than the 0.5% of >18 months.<br><br>
I would definitely bring the subject of VBAC, even if it's about your own. If she says she can't because they're spaced too close, just say "Oh, well I know several women that had them that close together." Because you "know" them online <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"> Planting the seed is the main thing, because too often women don't even consider it an option.<br><br>
She might have a harder time finding an OB/MW to attend. I got turned down by a couple MWs because they weren't 18 months apart or more.
 

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I was allowed to attempt VBAC at 13 months apart - I labored 28 hours (most up and moving but monitored) I didn't get't my VBAC but that was because my uterine muscles where still too weak. I had a very lenghty discustion with my MW and OB both before and after my DD was born, they felt that the VBAC was safe BUT that the closer the spacing the less time the muscles themselfs have had to heal and gain the strenght to contract properly - and in the end thats what happend.<br>
I was allowed to attempt again 16m later with my youngest - again labored long and hard(24h) but the contractions where ineffective. In niether case was I confined to bed or given/had anything done to speed labor along.<br>
I would say that you should encourage her to try - even if she dosn't succeed the labor is good for baby and you know that baby is ready (assuming that it's not Pre-trem). But unfortunatly highter persentage short term VBAC do fail do to uterine failure (I have a couple of studies - one done at our local hospital, but that dosn't stop them from offering them)<br>
A friend of mine just had a VBAC 16 months after her son at that hospital but it was a looooooong hard road for her - 51 hours of labour and she spent a week in hospital recovering because she was so weak from the labor and had lost alot of blood from some tearing.
 
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