Considering c-section - what's the likely impact on baby?

[RoyaUK]

I'm 35 weeks and despite really wanting a VBA2C, i am looking at going along with the hospital recommendation for an 'elective' c-section.

Reason being, the incision made in the last (emergency) c-section was an inverted t-shape (which i'm angry about) and the risks (for rupture) are higher than just a normal repeat lateral incision . no data exists to say what the risks are because woman who have this done just have another c-section it seems.

So it seems my options may be:

1) spontaneous labour at home with my independent midwife for as long as possible then transfer to hospital (for hopefully a natural birth)
2) spontaneous labour at home for a short period then into hospital (who will most likely whisk me into theatre for an 'emergency' c-section as they won't want to manage the labour)
3) going along on the scheduled date and be cut open without any labour happening.

I'm really interested to find out the benefit of option 2 - letting labour start (or at least pre-labour) and then going to hospital - for the baby.

Also if anyone has laboured after a non-normal incision i'd love to hear your experience.

[Emma1979]

hello, i don't have much factual advice, more just 'what i would probably do in your situation'... if you aren't comfortable trying to opt for a vag birth, i would probably go with option 2.... this way you know that baby is 100% ready for the outside world, as you have gone into labour yourself, i have also heard/read that even a small amount of labour/contractions is benefical for you and the baby, something to do with hormones released etc, i'm sure someone will clarify...
good luck with whatever you decide - maybe someone has some stats or research on vbacs for t shaped incisions... is your hospital very pro vbac? just wondering, mine is super duper very pro vbac, would be interesting to know their take on a vbac in these circumstances.

[Emma1979]

just read this on vbac.com

"Sometimes a woman may have a "T" or "J" shaped scar on the uterus or one that resembles an inverted "T". These scars are very rare. It is estimated that between 4 and 9% of "T" shaped uterine scars are at risk for rupture."

[sneakysparkle]

I think the benefit of option 2 is obviously baby being ready, but also I read in one of Henci Goer's books that there are certain hormones that are released when you are in labour that aid in the babies transition from womb to outside world - sorry i know thats a bit vague, but I read the book a while ago!
Hopefully someone with a better idea will pop in!

All the best with your decision

[Traveller]

When you go into labour naturally your body and your baby are flooded with oxytocin, which help you prepare to breastfeed and help your baby and you bond together. Not only this but if you labour spontaneously then you know your baby is ready, and your dates are not wrong (as they can be by up to 2 weeks in many cases).

However VBAC with an inverted t-shape scar need not be a barrier to vaginal birth full stop. Have a look at ICAN's website (International Cesarean Awareness Network) or Birthrites which I am sure will have information on the topic.

Good luck whatever you decide

T
xx

[jessicaanne010]

There actually was a study done on the risk of rupture after a classical, Inv T or J incision in Columbus, Ohio a few years ago. The Landon Study (I can send you a copy if you want it) found that the risk of rupture after one of these incisions was only 1.9%, giving you a 98% chance of NOT rupturing. Finding a care provider to assist with a VBAC after one of these incisions is fairly difficult.

I had a VBAC after an Inverted T and I know several other women that have too. :-) Our stories are here - Pregnancy and Birth. I also own the Life_After_InvT Yahoo group for women who've had one of these incisions. Feel free to join the Yahoo group or contact me privately.

Good luck!
Jessica

[IwishIknew]

First off, I don't want to scare you, but I wish I had know more information before deciding on a VBAC myself.

I had one c-section for failure to progress and was not told I had an inverted-T incision.

I decided to go for a VBAC with my 2nd child and due to some concerns about my daughter's heart rate and size, I was given a cervical ripening drug to help induce labor one day before my EDD.

After three hours in light labor (only got to 3cm), my uterus ruptured and I lost my daughter. They were able to save my uterus, but it required 2 hours of surgery and 9 layers of stitches due to the prior inverted T incision.

I was told the risk of rupturing during a VBAC with an inverted T-incision is similar to that of a classical incision or around 10%-15%. Any induction ups the risk to up to 30%. They told me if they knew about the inverted T, they would have never let me attempt a VBAC. I am a member of a support group for women that experienced uterine ruptures. Several had children that survived the rupture without any problems, several have children with mild to profound long-term health problems due to the rupture and the majority lost their babies.

I just passed my daughter's one year birth/death day and there is not a day that goes by that I wish I had known about the inverted T incision. Of course I am biased and will tell you the risk of any labor is not worth potentially losing your baby or your own life. I only came across your posting because I still scour the Internet trying to find answers, to which there are few. Uterine rupture is rare enough that statistics don't really help- especially if you have any other issues like a different type of incision or breech presentation, etc. The rupture can happen very quickly, and the baby must be taken out in less that 10 minutes, which is unlikely if you rupture at home. I only posted my story here because I wish I had known about my incision and heard a similar story about a year ago.

[Traveller]

IwishIknew, what a heartbreaking story and I am so sorry for your loss. How wonderful that you are strong enough to use your own experiences to support other women who have lost a child through uterine rupture.

I am surprised that you were induced for your VBAC though as I thought that this was generally advised against regardless of the type of incision. Do you know is this practice common in Australia?

[jessicaanne010]

Grr, I responded to this yesterday but my post disappeared. :-(

According to the Landon Study (2006?) the risk of rupture after a Classical, Inverted T or J incision is only 1.9%. I had a VBAC after an Inverted T and I know a few other women who did too. Our stories are here: Pregnancy and Birth

Please at least consider waiting until you go into labor to have a c-section there are so many benefits for your baby.

IwishIknew - My deepest sympathies to you. I am so sorry that you lost your daughter. I hate to bring this up, but was the cervical ripening drug Cytotec? That drug is known to cause uterine ruptures, there is a warning from the manufacturer NOT to use it for a woman during labor.

In the case of uterine rupture, catastrophic ruptures like yours are rare, 1 in 2000 I think. Even if you are IN a hospital it is truly rare to actually get into a surgical room in under 30 minutes. I'm sorry, I cannot imagine how painful this is for you, but your information is not accurate.

Any of you that had an Inverted T incision are welcome to join my Yahoo Group - Life_After_InvT. We are a relatively small group, but we are there are supportive.

[girlonamission]

I am surprised that you were induced for your VBAC though as I thought that this was generally advised against regardless of the type of incision. Do you know is this practice common in Australia?

I find this surprising too, I know when my waters broke at 35.5 weeks with DS2 but no labour/contractions followed, I was taken in for a repeat C-section. There wasn't even any consideration made for inducing.

However having said that, I do know of a friend who found herself in a very similar situation (a different hospital though) and the doctors were talking about inducing her when her waters broke but labour didn't start (she was hoping to attempt a VBAC) but from her own research she refused to be induced based on the risks she felt would be involved.

RoyaUK, I'd like to look into a VBA2C if we have a 3rd child so I'll be watching this thread closeley

I'm so sorry for the loss of your precious daughter IwishIknew

[IwishIknew]

Thanks for your thoughts. Losing my daughter was the hardest things I've ever gone through and I hope no one else has to live with the guilt of a decision they made (VBAC) causing the death of their baby. Despite what I've been through, I am still supportive of VBACs IF you have the whole story about prior c-sections AND you do not have any added risk factors. Yes, what I went through is a rare, but the new members that come to my support group are evidence that it happens too often (which is at all). Most of the newest members were not induced, just VBACs and they didn't have any known risk factors beyond a prior C-section.

No, the drug wasn't cytotec...I'd have to look up the name, but when I looked in the past, it was a different type of drug. And yes, my doctor went against VBAC protocols when inducing me. I didn't know about the problems with induction and I trusted she was making the right, medically sound decision. I think she believed the riping agent wouldn't work and I'd end up with a c-section anyways, but she wanted to give me a 'chance' at VBAC because of my preference.

Honestly, I do not believe in statistics anymore. I quoted the statistics my doctors and a specialist gave me at the time. Whether the chance is 1.9 out of 100 or 10 out of 100, I would tell someone to listen to their heart rather than the numbers. I wanted the 'natural' experience so much for me and my baby girl that I went against my gut feeling that I should go with a repeat C. Ultimately, we all have to live with the decisions we make. I just wanted to present a 'real life' example in case it could help someone.