Hi Sam,
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 is
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,
but my gyno (not the one who delivered my last three) told me last year that
isn't so. The new uterine incision is not made over the old one. I don't
really know, but it does make sense that if incisions are considered to weaken
the uterus then multiple incisions would be weaker that just one.
My personal story: My first baby was born by c-section in 1980 for CPD. My
original OB told me that I would not be able to have more than 3 babies because
my uterus would be too "flabby". I could have my 3 sections and then have my
tubes tied. Btw, this OB did do VBACs and I heard that he let one woman
deliver in his office suite. With my second baby in '83, I had a repeat c-section
with no labor so that my husband could attend the birth. This was hospital
policy. With Baby Number Three, we'd moved to Greenville and I switched
doctors. I'd read Silent Knife, too. I was determined to try a VBAC. I was a little
concerned about my incision though. I've got a classical skin incison. I
knew that the uterine and skin incision didn't always match, but I had no reason
to doubt that I had a classical uterine cut. You know, flabby uterus and
all. I'll never forget my new OB showing me "low transverse incision" on my
medical records. Btw, a classical incision would not have disqualified me from a
VBAC at this practice. Theresa was born by c-section after a decent labor due
to fetal distress. I did have a little separation of my old scar, but my OB
thought it was basically of no consequence. I didn't stop at three babies and
my new doc never even mentioned that I shouldn't have more babies. My fourth
baby was born almost 4 months early in '87. Katherine weighed 900 g. My
doctor said I didn't need a c-section for a 2 pound baby so Katherine was a VBAC.
My fifth -and last- baby was full-term. Rachel's birth was not only a VBAC,
but it was as close to perfect as it could be. My old flabby uterus held up
just fine.
Warmly,
Carol Kelley LLLL
Taylors, SC USA
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