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 apologize for not writing in so long. I’ve been busy with various projects including producing my 6 hour program “The Truth About VBAC” to be released online this summer! Subscribe to my newsletter to be informed of this and future classes!
I’ve been responding to many questions over on my Facebook page and have been trying to think of ways to archive those discussions here for future reference. Then the obvious answer appeared… post the questions and answers here and link back to the original question posted on Facebook! So, here we go! I look forward to blogging more […]
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. […]
Some care providers discourage epidurals in VBAC moms fearing that it will mask the symptoms of uterine rupture (namely abdominal pain) and delay diagnosis resulting in a poor outcome for baby and to a lesser extent, mom Other care providers suggest or even require VBAC moms to have an epidural so that a cesarean can quickly take place if needed. Which philosophy does the evidence support?
Review of 14 VBAC studies
I recently came across a study entitled “The Role of Epidural Anesthesia in Trial of Labor” (Johnson, 1990) that reviewed 14 VBAC studies. Johnson found […]
A mom recently asked, “I know I’m asking for a lot, but is there a list of rupture rates by weeks gestation ?”
This is a great question as many women are under pressure from their care provider to go into labor as early as 37 weeks, but more commonly 40 weeks, or they will have a repeat cesarean.
Let’s first look at what ACOG says in their 2010 VBAC recommendations,
Studies evaluating the association of gestational age with VBAC outcomes have consistently demonstrated decreased VBAC rates in women who undertake TOLAC [trial of labor after cesarean] beyond 40 weeks […]
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. […]
“There is a major misperception that TOLAC [trial of labor after cesarean] is extremely risky” – Mona Lydon-Rochelle MD, March 2010. “In terms of VBAC, “your risk is really, really quite low” – George Macones MD, March 2010. Both Drs. Macones and Lyndon-Rochelle are obstetricians and researchers who made these statements at the 2010 NIH [National Institutes of Health] VBAC Conference. Now you may think, “Wait a sec. Everything I’ve heard from my family, friends, and medical provider is how risky VBAC is and how cesareans are the conservative, prudent, and safest choice.” Why the discrepancy between the statements of these two doctor researchers and the conventional wisdom prevalent in America? […]
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. […]
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 […]
Suzanne recently left this comment in response to the article, I’m pregnant and want a VBAC, what do I do?
Hi. I’m new to your site and just trying to get some more info on VBAC. My daughter was a normal vaginal delivery. My second pregnancy(a surrogate pregnancy) was also a normal vaginal delivery. My third (also a surrogate pregnancy) was twins. I had planned to attempt a vaginal delivery with the twins with the support of my OB as long as Baby A was head down. Unfortunately she was breech and I ended up with a c-section at 36 […]
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 […]
There is this idea that if you don’t VBAC and you schedule a repeat cesarean, that you will be safe from complications. This is because during a “VBAC counsel,” women are often told of the risks of VBAC, namely uterine rupture, but they are rarely told the risks of repeat cesareans in their current and future pregnancies.
Abnormal placental implantation is one risk of cesareans that only present themselves when you get pregnant again.
Women who expect to only have two children, and thus opt for a repeat cesarean, might think that not VBACing is the safer, and more controlled […]
This is a question that I’ve heard a lot.
Here is the three second answer: VBACs got a bad rap in the 1990s before we understood the increased risk of rupture during an induced VBAC labor, especially with Cytotec. Even if your OB is supportive, s/he may be under pressure from hospital administrators, or other OBs in their practice, who feel differently. Finally, your OB might have experienced a recent lawsuit, uterine rupture, or other bad outcome that influences the way they counsel you.
In the 90s, babies and moms were unnecessarily injured and died when VBAC labors were induced […]
A couple weeks ago Virginia from Switzerland left this comment:
I am planning to have a vbac at a hospital in Geneva, Switzerland. In general, they are very supportive of vbacs here.
It is common practice here to measure the uterine scar at 37 weeks using a sonogram. Apparently, if the scar tissue is 3.5mm or higher – it is very unlikely for a rupture. Mine happens to be 2.95mm. The hospital staff tells me I have a 3 – 4% chance of a rupture versus a standard .05% chance of rupture. They warned me that I will be monitored […]