Q: Is there any evidence to support double layer suturing over single layer?
A: Conclusive evidence on single vs dual suture does not exist. Also note that ACOG does not say one form of closure is better than another in their VBAC guidelines.
Bujold (2012) stated, “Although there is a growing body of evidence that the technique for uterine closure can be crucial for uterine scar healing, strong evidence regarding optimal techniques is scarce and there currently exist no national or international guidelines on which obstetricians-gynecologists and surgeons can rely.”
Bujold provides a good review of the literature, so you […]
I hear a lot, “What’s the big deal about cesareans? What difference does it really make if you have a cesarean?” Of course, if a cesarean is medically necessary, then the benefits outweigh the risks. But in the absence of a medical reason, the risks of cesareans must be carefully considered. […]
Becky recently ask this question on the VBAC Facts Community:”I read somewhere that the risk of uterine rupture is actually higher during pregnancy than during birth. Does anyone have a source for this?” […]
While these statements are very comforting, as birth myths tend to be, they are false comparisons. We can accurately and fairly compare the risks of a TOLAC to the risks of a repeat cesarean or the risks of a first time time. However, it is a misleading to compare the risks of birth to non-birth events. […]
I have often heard moms say “if two numbers are less than 1%, they are similar.” Typically this is expressed while comparing the risks of rupture in an unscarred versus scarred uterus. But is this true? How different can two numbers less than 1% be? […]
Spontaneous labor is always preferable to induced or augmented labor but there are medical conditions that can necessitate the immediate birth of a baby. It’s nice for those women for whom vaginal birth is still an option to have a choice: gentle induction/ augmentation or repeat cesarean. Of course, informed consent reviewing the risks and benefits of their options is essential. Some women might be more comfortable scheduling a cesarean whereas others might want to give a gentle Pitocin and/or Foley catheter induction a go. […]
Some new research questions the idea that women who are “too posh to push” are responsible for America’s rising cesarean rate. The work of University of Arizona sociologist Louise Roth has been featured in an University of Arizona UA News article dated April 13, 2012.
Watch for Roth’s research which will be “published in the May issue of the sociology journal Social Problems, published by the Society for the Study of Social Problems.”
I’ve highlighted a few passages for those who like to skim.
By Jeff Harrison, University Communications, April 13, 2012
UA sociologist Louise Roth says the increasing […]
How many times have you heard “Only 6% of uterine ruptures are catastrophic” or “Uterine rupture not only happens less that one percent of the time, but the vast majority of ruptures are non-catastrophic?” But what does that mean? Does that mean only 6% of uterine ruptures are “complete” ruptures? Result in maternal death? Infant death? Serious injury to mom or baby? This article will explain to you the difference between uterine rupture and uterine dehiscence as well as explain the source and meaning of the 6% statistic. […]
1/18/12 – The difference in uterine rupture (UR) rates between unscarred and scarred uteri is significant: 1 in 14,286 in an unscarred uterus and 1 in 156 in a scarred uterus. Another way to express this is: 0.7 in 10,000 (0.007%) in an unscarred uterus and 64 in 10,000 (0.64%) in a scarred uterus. This 91 times greater risk does not mean that the risk of UR is so large in a scarred mom, it’s that it’s so very, very small in an unscarred mom.
I came across a couple different bits of (mis)information […]
Update 1/20/12 – Someone who believed this birth myth to be true, told me that the source of this information was an OB from St. Louis who presented at the 2011 ICAN conference. I contacted ICAN and they said that the person must be referring to Dr. George Macones. Yet, no one on the ICAN Board, who were seated at the front table during his presentation, remembers him saying that induced, unscarred women have the same risk of uterine rupture as a VBAC mom. And I would think that if he gave a stat like, everyone would have remembered because […]
When someone understates the risk of UR, I think it’s just as important the clarify as it is when someone overstates the risk. How else are women to make an informed decision? Just as it’s plain wrong for an OB to tell a woman with one prior low transverse cesarean that she has a 20% risk of rupture, it’s equally wrong when VBAC advocates say the risk is virtually non-existent.
Over the years, I have heard the statement: “You are more likely to be struck by lightning or bitten by a shark than experience uterine rupture!”
Today I’m going to […]