VBA2C and inverted t incision - is it too risky?

I've posted a couple of times in this section and really appreciated the answers you've all given so i'm putting this one out there too....

Baby #3 is due 11 Feb. previous 2 babies born by 'emergency' c-section and unfortunately the incision made last time seems to be an inverted t shaped.

Not much data available about risk figures as women are advised to have a repeat c-section. Going off what is available, the risk figures for rupture range from 2 - 8%. But the studies all lump classical, J shaped and inverted T shaped incisions together.

There's no way of knowing how high the vertical section of the scar is as it wasn't written down. My understanding is if it is just restricted to the lower segment, it is much stronger than if the cut ran into the upper area of the uterus.

Reason for this type of incision was 'shoulder dystocia' which meant the shoulder was stuck. it's been mentioned to me by medical professionals that it may have been a question of competence or lack of skill but there's nothing i can do about that now.

So with this unknown of scar size, would you still try VBA2C?

I have an independent midwife who will come over whenever i want her to and the plan would be to transfer to hospital at about 4 cm (active labour stage). I trust her and my husband but it was made really clear to me yesterday that the hospital staff will want to do a c-section the minute i get there and that would be something i'd had to work through whilst in labour......

Do you think i'm taking a stupid risk by going for vba2c in this circumstance?

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I don't personally know what the figures are, but from recollection when I read studies on VBAC 4 years ago, the "classical" c/s scar was the most likely to rupture, followed by the inverted T, followed by the J, followed by the LUSCS.

I'd be wary of a VBAC in your circumstances, but it is entirely possible that you may achieve one.

Wishing you all the best, both for making your decision and for your birth.

I would be wary of going for a VBA2C after an inverted T. I would definitely get heaps of information from an OB and your independant midwife and then make your decision. Best of luck with it.

Have you read any information from the birthrites web site. They specialise in VBAC and might be able to help. Did you dilate at all with either of your last pregnancy's? If your cervix has already been fully dilated this will greatly increase your chances of a VBAC. Good luck finding a hospital or Dr who will support you. The only one I know who will do VBAC2 is Warragul and Dr Simon but he is leaving and going to Trarlagon.

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So with this unknown of scar size, would you still try VBA2C?

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Do you think i'm taking a stupid risk by going for vba2c in this circumstance?

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No, I don't think you are stupid, I did it! I had an induced vag, a low transverse c-section for brow presentation, an Inverted T for a transverse presentation and then I VBAC'd. I know a few other women who have as well.

Good luck!
Jessica

I know of a VBA2C story with such an scar.. I will pm it to you :)
Not sure of the numbers off the top of my head tho.

Thanks for all your replies. Well I've had a few conversations now with the medical team at the hospital and they are supportive of me now that i've demonstrated i've done my homework, i understand the risks and symptoms of rupture and that we will keep an eye on me as we go along.

So far it's really helped that i've done my research and been able to have an academic conversation with them and the head of the department has also reviewed my file and confirmed that they will support me.

Certainly the tactic they took a couple of months ago (book me in for a repeat c-section at 39 wks) to now ('allow' spontaneous labour and if post dates review regularly) has changed especially since i've become more informed. It's been great to learn from BB about the possibilities of VBA2C.

Of course, we'll have to see what happens on the day regarding who is actually caring for me in the hospital but my IM is very supportive and will be with me at home until we transfer and then that should help keep me focused I think if the hospital team on duty are reluctant.

In the mean time, i need to go for an iron infusion on Friday as my ferritin levels and Haemaglobin levels are pretty low. I'm taking it as a positive that they should be boosted in time for me to give me energy to cope with birth and the life afterwards!

Wish me luck!

good luck hun :)

i am aiming for a VBA3C next year...need to lose weight first then commence IVF and get preggers

Good luck RUK :D

HI,
Please let me know how you go with your VBAC as I will hopefully be finding myself in the same position in November!
I had an inverted T in 2007 (son born prematurely breech at 30weeks for severe PET and HELLP), then a LSCS in 2009 (was VBACing, but gave up because I became too scared to continue because I had no confidence in my midwife, whom I had never laid eyes on before, and I was stuck to the bed on a monitor that lost contact every time I even thought about moving!). (I will add that the Ob suggested that I have an epidural and continue because he thought I was doing okay. Lots of stupid stuff went through my head -I didn't want to keep my husband awake all night waiting!!; and the comments people had made about VBAC being a stupid idea).
Anyway, I am hoping to VBAC in November with no 3.
My understanding is that the rate of rupture for Inverted T is around 2-9%, however that also includes scar dehiscence rates. So that means that it is 91-98% succesful/safe!!
Where are you located?
Good luck with it all and please let us know!
Mel.

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My understanding is that the rate of rupture for Inverted T is around 2-9%, however that also includes scar dehiscence rates. So that means that it is 91-98% succesful/safe!!
Where are you located?
Good luck with it all and please let us know!
Mel.

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I'm not the OP, but I wanted to throw my 2 cents in. :-) You are correct about the rupture rate. In your case, you might be at the higher end of that rate because your Inv T was earlier. Was your second baby term? If so, then I might not worry so much about it because as far as that is concerned you have proven the vertical part of your scar.

Good luck on your VBAC attempt.
Jessica

My second was born at 39 weeks.
Now I just have to wait...
I am pretty sure my Ob from last preg will be supportive, but seeing him involves travelling 1.5hours each way and with my 2 boys. But, I will do it if that's my only option.
My Hubby is happy for me to VBA2C. He trusts my decisions (or he wont get any dinner!! just kidding!).

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My second was born at 39 weeks.
I have checked out your stuff, Jessica, and joined the group. Thanks.
Now I just have to wait...
I am pretty sure my Ob from last preg will be supportive, but seeing him involves travelling 1.5hours each way and with my 2 boys. But, I will do it if that's my only option.
My Hubby is happy for me to VBA2C. He trusts my decisions (or he wont get any dinner!! just kidding!).

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Yep, I saw that! :-) Traveling sucks, but it can be worth it. My midwives for my first VBAC were an hour away. Having a supportive hubby helps SO much! He's a good man. lol about the dinner thing. ;)

Hi there,

Well this is one of my first posts since having my beautiful third daughter a month ago. It's taken me a while to build up the strength to face what happened.

To cut to the end result, I ended up with another c-section. The journey though getting there took an unexpected turn.

I haven't debriefed online yet so this may be my debrief. Essentially, prior to labour, I was physically in good shape. I was swimming 2 - 3 times a week, walking a lot, eating well, positioning well (optimal fetal positioning was an obsession!) and feeling great. I was practicing the yoga I had previously learnt. I was seeing a good chiropractor weekly (towards the end). Many people commented on how well i looked.

Intellectually, i believed I was as informed as I could have been. I joined Jessica's group (which was great to learn from), read many many birthing books specifically Silent Knife, Thinking Womans Guide, a couple of Sheila Kitzinger books, Sarah Buckley's Gentle Birth, Janet Balaskas Water Birth, and more. I also got my hands on many research studies on inverted t-incision and VBAC and VBA2C and actually got beyond just the percentage statistic and learnt about the sample sizes and what stage rupture happened in those affected groups etc. Essentially we're in such a small group inverted t often gets lumped together with classical scars which are more likely to rupture hence the range of stats.

I had hired a supportive and wonderful independent midwife (who made the world of difference) and my husband eventually came on board.

There was a lot of negotiation I had to do with the hospital and eventually gained acceptance that they would support me. As i was in the public system, I met numerous doctors and some were more fear inducing than others. But by 37 weeks, I had 'sign off' from the head of the department that i would be supported should i arrive having gone into spontaneous labour. I felt like the negotiation stage had passed.

I felt like I was as prepared as I could be - physically & mentally. Looking back on it, I probably should have spent more time concentrating on the actual process of labour and truely visualising giving birth.

So then at 41 weeks (after fighting the hospital again on a c-section date), I went into spontaneous labour. It was 10 pm on a Monday night. I had 10 minutely contractions (at one point stretching to 30 minutely for a short period) essentially 24 hours a day for 6 days....yes, until the following Saturday. The contractions made me work hard and were challenging.

Such a long prelabour was something i hadn't anticipated. My private midwife was very reassuring that this was not so unusual and as the days went by I tried everything to try to progress them. My TENS machine & a hotwater bottle became my new best friends! Accupuncture, more chiro, eating well, homeopathy. My mum was staying with us so looking after my other children. And despite the contractions making me work hard, I was getting more and more tired (no real sleep for days).

On the 5th night, my waters broke. Still no progression. A few hours previously, my midwife had done an internal to try to do a stretch & sweep. She determined i was effacing but not dilated yet so didn't want to push up. However, this brought back horrible memories of internals done at my first labour - this may have triggered some fear reason why I wasn't dilating.

The next day, the Saturday, I felt my options were becoming limited. I was exhausted, water broken, and now had an excrutiating pain in my coccyx which was persistant. Still the contractions were only 10 minutely.

I felt for my mental sanity, I should call it a day and take myself in for a c-section. So easy to write now but it was such a tough and emotional decision. I couldn't envisage my contractions getting close r and even if they did, with this new pain I couldn't imagine going for a few more hours without drugs to get through it. I thought it more likely the hospital making the decision for me to do a c-section and I didn't want that loss of control again.

This is something that I still battle with myself all throughout the day every day, more than a month on. I feel disappointed in myself and wonder if I should have persevered. My husband assures me that I was just beyond exhausted after 6 days of no sleep, trying many things to push things along and then this new pain in my spine. It wasn't a decision i took lightly but I am grieving the birth i'll never get to have. This is something i'll have to learn to accept.

My DD3 was born almost 24 hrs after my waters broke, so in truth I wasn't that far from a hospital decision anyway as they wouldn't induce me. In theatre, the surgeon confirmed that there was no seperation, no dehissance and no problem with my uterus. My body was strong.

Some positives I took from it was the strong lesson that it's YOUR BODY, YOUR CHOICE. Even at the end, I didn't agree to an internal (once i'd consented to a c-section) that the surgeon wanted to do because it had no medical value. I did ask him to do it once the spinal was in though (for my own curiousity - i was only 1 cm dilated at the end). I only did the CTG standing up - sitting down was unbearable during contractions. And i insisted on breastfeeding in theatre. There was resistance to this - staff shortages - but I stood firm on this.

So to conclude - and if you've got this far, thanks for reading!! - i took the decision to have a c-section in the end. It was my own , with my DH, decision and felt it was the only thing I could have done at the time. I am now grieving the birth i'll never get to have - we won't be having any more babies - and have to learn to come to terms with it.

There were many lessons i learnt along the way - be strong, be educated, be supported, have faith in yourself, explore your other births and try to identify any mental blockages that could hinder your progress before you go into labour, remember the medical professionals are not the police - ask 'why' about every proposal and remember you have a choice.

Then I look at my beautiful baby and other daughters and i am back in the moment of raising a caotic household!!

Thanks for reading and I wish you every luck with your birth. Feel free to ask any more questions if you want to. Good luck!

Much love and healing to you.

Thank you so much for sharing your story.

Wow, what a story. I feel terrible for you that you will have to deal with this loss.
And it is like a loss. You had focused on your ideal birth for so long, and you didn't get that.
That's how I felt after I had my first son (I was going really well during my pregnancy and then I became extremely unwell and had an emergency c-section at 30 weeks for severe PE and HELLP syndrome. I wasn't allowed to hold my son for 4 days and I didn't see him for 24hrs to start with because they had to take him straight away from the theatre to resus him. As they were doing the c-section I heard the Ob say, "he's stuck, I'm going to have to do a T cut" I knew exactly what she was talking about and wanted to scream at her to take a breath and try again. I didn't, and now I have to deal with that)
While my second was another C-section, after some labour, I can take some comfort in it because it was my decision, not theirs that I had the LSCS. I did not know my midwife and she didn't seem confident (when she was anywhere near me), and therefore lost confidence in myself. I was doing really well at home and even on the 1.5hour car trip, but when I got in the hospital room and strapped up on the bed I was contracting every 2 mins, lasting between 45secs and 1.5mins. The midwife did a VE and said I was only 1-2cm. I thought I don't know if my scar will go for 8-9 more hours of this or if I can do it stuck to the bed. And amongst other reasons, I opted for the C-section. I know now that I definately could have done it and that I was dilating quite quickly (an hour later on the table I was 4-5cm), hence the reason for my crazy contraction rate so 'early' in labour!
I can only hope that time will heal you. That and your gorgeous baby!
Remember to let yourself grieve and make sure you debrief with your midwife and husband.
All the best and thankyou so much for sharing.
You did an amazing job!!
Mel.

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Well this is one of my first posts since having my beautiful third daughter a month ago. It's taken me a while to build up the strength to face what happened.

To cut to the end result, I ended up with another c-section. The journey though getting there took an unexpected turn.

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Congratulations on your new baby girl! I am so sorry that you ended up with another c-section, but in your position I probably would have made the same choice. You gave your baby the very best start in life that you could - you let her choose when it was time to come and you gave her the benefit of all that labor. :) It really was a good thing for her.

Take it easy on yourself, grieve as much as you feel you need to. You did a great job momma!

Thanks for sharing this!

For my only labour so far I too ended up with a c-section that I chose (after 2 hours pushing with no progress), albeit in very different circumstances. At the time I knew I was doing the right thing and I was making a choice that had to be made. Although agonising at the time, I felt I had done all I could do. Like you, it was only afterwards, knowing what I had missed out on that I began to analyse the situation and think I made the wrong choice. If only I had done this or that, etc. I should have stayed with my firm decision at the time, knowing I needed what I needed then and there. Analysing it with the benefit of hindsight was too analytical and took out the emotion of what was going on at the time and the exhaustion of it all. It's only now (2.5 years later) that I have my medical records, and when I read them again, I know what a marathon I went through and it reinforced my decision.

I guess what I'm saying is be at peace knowing that you thought about it and made a conscious decision at the time that was right for you.

Thanks so much for sharing. I had read and wondered how you went.

RoyalUK.

You tried so hard to acheive a vbac. I'm impressed with your determination. TBH if it was me I would have booked a repeat section with a Tcut! I'm not as brave as you and i'm in awe that you stuck out those contractions for 6 days!

However I understand that you are dissapointed and I don't mean to belittle your feelings. I just wanted you to know that you did an amazing job on keeping focused through so much.

I'm due today, 31st March, and am/was hoping to have a vbac. Everything is in my favour but i'm so tempted to ring my Dr today and get him to book me in for a repeat section. I'm very uncomfortable now and i'm afraid I will still end up with a section anyhow and so I feel like "taking charge" of the unknown.

But having read your supreme effort I think I can suck this up for another week (dr is happy for me to go to 41 wks).

As someone has already pointed out, in time you will look back and realise the huge effort you put in and you will, and should be, proud of that.

Thanks for sharing your story RoyaUK and I hope that by writing it down and getting it out you will be able to make piece with your decision and move past the grief that you are feeling.

You did an amazing job coping with 6 DAYS of prelabour. I don't think I would have been able to.

Congratulations on your baby girl :hug:

Thanks girls for all your support. I'm slowly coming to terms with the disappointment & grief i'm feeling. It really helps writing it & sharing it and reading your responses.

I saw a birth counsellor who helped me to go through the experience and we identified a couple of reasons why i feel the way I do. Interestingly one thing was that I'm used challenges and uncomfortable situations such as birth e.g. studying to a high level, raising a family on the other side of the planet from my family etc. But the normal response I get from putting in hard work and research is generally success e.g. in the workplace or academically. And this felt like failure - on my part.

This time round, I couldn't have done more I don't believe, if I tried - read all the books, hired an amazing IM, negotiated with the hospital successfully, was physically in shape, eating well etc. But nature was in control this time and my body really wasn't going into established labour plus I was experiencing excrutiating coccyx pain which will always be unexplained.

As time goes by, I am slowly thinking about it less and today DD3 smiled at me properly for the first time and that felt wonderful! Certainly helps in my recovery journey.

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I'm not the OP, but I wanted to throw my 2 cents in. :-) You are correct about the rupture rate. In your case, you might be at the higher end of that rate because your Inv T was earlier. Was your second baby term? If so, then I might not worry so much about it because as far as that is concerned you have proven the vertical part of your scar.

Good luck on your VBAC attempt.
Jessica

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Hi Jessica,
I was just wondering why having the inv T earlier would make the risk higher? I would have thought that it would mean it has had longer to heal and therefore be a lower risk??
Love to hear your thoughts.
Mel.

Well done RoyaUK, thankyou for posting your birth story. I am sorry that you are grieving for the normal birth you missed out on. It is a basic fundamental right of every woman to be able to give birth vaginally without assistance and to be able to breastfeed their child. You did everything within your powers to facilitate a normal birth, you were let down by the system. Your body was functioning well. Sometimes past experiences can interfere with the labour process and slow down the oxytocin release that is required to dilate the cervix. Sleep deprivation is a major cause of decreased dilatation. This is why simple relaxation techniques work so well to increase the oxytocin release for labour. The more relaxed you are, the more sleep you can achieve ( even if it is only between contractions) The deeper the state of relaxation, the more rest the uterine muscle receives. Give yourself a pat on the back for trying so hard, but don't blame yourself for the caesarean birth. Allow yourself time to grieve. Time will heal and dull the traumatic memories. Stay positive and allow yourself to have pride in the great job you have done and for the great mother you are. Enjoy your children, they are lucky to have such a great mum.

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Hi Jessica,
I was just wondering why having the inv T earlier would make the risk higher? I would have thought that it would mean it has had longer to heal and therefore be a lower risk??
Love to hear your thoughts.
Mel.

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I don't have the scientific reasoning behind it at the moment, but there was a presentation about it at the NIH VBAC Conf (in the US in March) that showed that c-sections for premature babies have led to more ruptures in subsequent VBAC attempts. It only raised the risk by 0.5%, but it did still raise it and that was regardless of the type of incision. I'm working on getting all of the sessions from that conference on the BirthAction website but having some technical difficulties at the moment.

Hi jessica,
I see you meant earlier as in earlier gestation and not as in birth order. Now that makes sense.
Thanks for clearing it up.
Mel.

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I see you meant earlier as in earlier gestation and not as in birth order. Now that makes sense.
Thanks for clearing it up.
Mel.

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No problem. :-)

There is an indepenant midwife in Adelaide that supported a VBA3C including a classical scar last year. Have you heard of Lisa Barret? http://www.homebirth.net.au/

I just thought I would mention her in case you hadn't heard of her.