>
I had a conversation with a perinatiologist a few years back about  
VBACs.  I believe that at the time we had had a few uterine ruptures  
in our LDR.  I wanted to know what was up and why there was so much  
concern about VBACs.  He explained to me that over the past few years,  
single layer closures had become common but they had found that single  
layer closures don't seem to hold up as well in labour thus the  
increase in uterine ruptures.  I believe that some OB's would  
recommend repeat cesarean birth if the uterus had been closed with a  
single layer.  Induction of labour with a VBAC is done carefully, if  
at all, most often always with oxytocin never prostiglandin gel,  
occasionally cervidil might be used.  The difference between gel,  
cervidil and oxytocin is that you can stop oxytocin and remove  
cervidil but you can take out the gel if the uterus becomes  
overstimulated.

Another factor in deciding on VBAC, is the length of time between  
pregnancies, I believe they prefer 2 years between pregnancies so that  
the uterus is well healed.

Yes it is possible for parts of the baby to be found in the abdominal  
cavity when the uterus has ruptured, though it is rare.  I think that  
it is more common to see what is called a "window" in the uterus when  
labour has been obstructed.  This occurs when the uterus has not  
ruptured but has stretched so thin that one can see through it at time  
of c/s.

I remember back in my student days, the abdominal scar being removed  
at time of a second abdominal surgery but I never remember seeing this  
done during a cesarean for either the abdominal or uterine scar during  
the time I worked in LDR.

Cordelia


> Subject: Re: C-Sections and VBACs and somesuches
>
> =20
> Hi Sam,
> =20
> In a message dated 10/27/2008 5:13:27 P.M. Pacific Daylight Time,  
> you  wrote=
> :
>
> Knowing  about the "new method" (single layer closure) of uterine  
> closure, I
> wonder  about the difference in amount of muscle removed. Each time  
> there  i=
> s
> another cesarean, the old scar is removed and a new one created. Is   
> there
> any sizeable difference between the amount of tissue used as   
> comparing the
> multiple layer closure and the single layer closure? I don't  know  
> if that
> would make a difference or not, but most OBs around here are  using  
> the
> single layer closure which is faster than the multiple. There is   
> increased
> risk of placental accreta (placenta growing through the old   
> incision) with
> single layer closure, but I don't know about amount of scar  created  
> or
> tissue removed through additional  surgery
>
>
> Is it true that the old *uterine* scar is removed? I'd always  
> thought that,=20=
> =20
> but my gyno (not the one who delivered my last three)  told me last   
> year th=
> at=20
> isn't so. The new uterine incision is not made over the old one. I   
> don't=20
> really know, but it does make sense that if incisions are considered  
> to  wea=
> ken=20
> the uterus then multiple incisions would be weaker that just one.
> =20
> My personal story: My first baby was born by c-section in 1980 for  
> CPD. My =20
> original OB told me that I would not be able to have more than 3  
> babies beca=
> use=20
> my uterus would be too "flabby". I could have my 3 sections and then  
> have m=
> y=20
> tubes tied. Btw, this OB did do VBACs and I heard that he let one  
> woman=20
> deliver  in his office suite. With my second baby in '83, I had a  
> repeat c-s=
> ection=20
> with  no labor so that my husband could attend the birth. This was  
> hospital=20
> policy.  With Baby Number Three, we'd moved to Greenville and I  
> switched=20
> doctors. I'd  read Silent Knife, too. I was determined to try a  
> VBAC. I was=20=
> a little=20
> concerned  about my incision though. I've got a classical skin  
> incison. I=20
> knew that the  uterine and skin incision didn't always match, but I  
> had no r=
> eason=20
> to doubt that  I had a classical uterine cut. You know, flabby  
> uterus and=20
> all. I'll never  forget my new OB showing me "low transverse  
> incision" on my=
> =20
> medical records.  Btw, a classical incision would not have  
> disqualified me f=
> rom a=20
> VBAC at this  practice. Theresa was born by c-section after a decent  
> labor d=
> ue=20
> to fetal  distress. I did have a little separation of my old scar,  
> but my OB=
> =20
> thought it  was basically of no consequence. I didn't stop at three  
> babies a=
> nd=20
> my new doc  never even mentioned that I shouldn't have more babies.  
> My fourt=
> h=20
> baby was born  almost 4 months early in '87. Katherine weighed 900  
> g. My=20
> doctor said I didn't  need a c-section for a 2 pound baby so  
> Katherine was a=
> VBAC.=20
> My fifth -and last-  baby was full-term. Rachel's birth was not only  
> a VBAC,=
> =20
> but it was as close to  perfect as it could be. My old flabby uterus  
> held up=
> =20
> just fine.
> =20
> Warmly,
> Carol Kelley   LLLL
> Taylors, SC  USA
>
>
> Date:    Mon, 27 Oct 2008 23:17:40 -0400
> From:    Sam <[log in to unmask]>
> Subject: Re: C-Sections and VBACs and somesuches
>
> Carol, your "old flabby uterus" and Edwina's "aged breasts." Amazing =
> what our bodies do when WE believe in them! The issue is to help  
> others =
> understand and accept. It is frustrating to know that new nurses are =
> being given information that doesn't match reality, but that's the  
> way =
> it is.
>
> I don't know if they remove scar tissue on the uterus or not. I'll  
> ask =
> at my visit on Thursday. They do remove the skin incision, which is  
> why =
> the scar gets larger and larger each time. My pt last week had a  
> small =
> scar with her first, now it's almost hip to hip with her 3rd surgery.
>
> The uterine incision is a different story. The closure method has =
> changed, but as I mentioned, I don't know how/if the closure changes  
> the =
> musculature of the uterus.=20
>
> BTW, my "inadequate pelvis" which wasn't able to birth an almost 9#  
> baby =
> was "amazingly" able to birth a 9#10 baby, and 2 10#8oz babies  
> without =
> any problem... (given a much better situation ;o))
>
> Best wishes,
> Sam=20
>
>             ***********************************************
>

             ***********************************************

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