anyone heard of this??

[mykids]

Hi everyone,

I was planning to try for a VBA2C in April next year. So far everything was going well I have a great midwife and supportive OB (Lionel vaginal) and was feeling great about it until I recieved my hospital records today!!
My midwife wanted to see how far my first labour went so I got the hospital to send the info to me.

Anyway it finaly arrived today and I am really worried and now feel sick about my VBA2C. It appears my last ceasarean although was a typical low transverse incision (horizontal) she also cut 3cm down towards my pubic bone on the left side so I have an offset T shape . Does anyone know if this makes my VBA2C more risky????????

I have tried looking it up but can only find info on inverted T incicion or a high T incision, I cant find anything about a low transverse incision that extends down.
I cant get hold of my midwife til tomorrow and I dont see my OB till end of december.
Does anyone know or had this and still got the OK for a VBAC or VBA2C?

I know its just the pregnancy hormones here but I feel like I am going to be ripped off again and it is almost bringing me to tears because I just feel like its going to be bad news.

Thank you for reading this and I hope someone has some info for me.

[*suz1*]

Hi mykids,

Like you, all the info on VBAC I've found has been on inverted T scars with the t part extending back up towards the navel.

I don't see why you can't VBA2C with your scar. Even with a regular low transverse incision I was given an ultrasound at 34 weeks to ensure the lower segment of my uterus was thick enough, that my scar had no defects and my placenta was well out of the way. So I don't see why you wouldn't be offered the same.

I wish you all the best with your VBA2C . You certainly have a good chance with your OB. Hopefully someone on BellyBelly has a VBAC story with a similar scar to you.

[Fleur]

Haven't heard of it sorry but wanted to pop in & wish you all the best.
Even if it does raise your risk it might not rule you out altogether - it doesn't impact at all.
Hopefully someone else will know...

[Indadhanu]

I have an odd 'T' where it kind of goes UP at my public bone about 2cm. I always thought it was where they used the clamp to hold the skin open or something (I have no idea, that was just the theory I came up with in my head!), but I wouldn't think it would make a VBAC/VBA2C more risky? Especially if you can't find any info on it. I always though a little bit at the edge up or down was fairly normal and inconsequental...?

[~mamaspice~]

I am no expert but I think this might just be okay. I think that the main issue with classical (vertical) or inverted T incision to the uterus when it comes to VBAC is that the upper portion of the uterus grows and thins a lot more during pregnancy than the lower segment does. Thus if the upper segment is scared there would be more chance of rupture during a VBAC because the scar could be weaker. If the T incision is still in the lower uterine segment then i would think it might be okay.
Try to stay positive and see what your OB and MW say.

[{sarah}]

Leash, the OP is referring to the scar on her uterus, you wouldn't be able to see it hun The bit where you scar goes at an odd angle would probably be where it tore, gross but as far as I know they only cut halfway & let the rest tear as much as needs be to get bub out. It's annoying cos on me, Z's scar was perfectly straight, but J's is wonky because the scar tissue wouldn't tear making half of the scar go wonky

But I digress.

I would maybe call your ob & ask the quick question - "found out xyz, will I still be able to have a VBAC?" & you never know, you may get a quick "yes" as an answer which will ease your mind. It could go either way but if it is really concerning you, just give him a call

[{sarah}]

Leash, the OP is referring to the scar on her uterus, you wouldn't be able to see it hun The bit where you scar goes at an odd angle would probably be where it tore, gross but as far as I know they only cut halfway & let the rest tear as much as needs be to get bub out. It's annoying cos on me, Z's scar was perfectly straight, but J's is wonky because the scar tissue wouldn't tear making half of the scar go wonky

But I digress.

I would maybe call your ob & ask the quick question - "found out xyz, will I still be able to have a VBAC?" & you never know, you may get a quick "yes" as an answer which will ease your mind. It could go either way but if it is really concerning you, just give him a call

[Indadhanu]

Ohhhhhhhhhhhhhh ok Sorry, I didn't read that bit! The dangers of posting while cooking dinner!!!!

[blackduckies]

WOW Sarah I had no idea that thats what happened, I just thought they cut the whole way????!!!
I don't really know the answer, but wanted to say I hope you get the chance!!! I would think that being such a small area that you would'nt be at anymore risk than normal, but like I said don't know for sure.

[mykids]

Thank you to everyone who relpied and send my goodluck wishes I truly appreciate it.

I dont know why I am so scared to bother professionals outside of my appointments I mean I am paying him so much I should get some sort of attention outside of my appointments if I am freaking out about something.

Anyway I finally called and he did call me back. He is just so 'matter affact' and I am struggling to figure Lionel out. He said that it did increase my chances of rupture and the report also said my uterus was very thin and he said with all that my increased risk had gone up to his higher percentage of 5% for rupture. He has very high stats which I cant find anywhere. He said that I could still try but I need to accept the risk not him - he keeps bloody saying that to me and it always makes me feel crap and makes me feel like I am taking this hugh risk but he is happy to oblige has long as i know it is a HUGH risk.
I should have been a little happy about the fact he said I could still try but I came away thinking does he just say yes to everyone wanting a VBA2C provided they understand the risks and are willing to take them?????????
I am back to being very underdecided about what I want to do so much in fact that I dont even want to think about it at all.
I will have to think of exactly I want to say to Lionel before I see him next and try and get more clarity from him

[paradise lost]

I am confused as to why an extra bit of scar into the lower segment of the uterus is a risk factor. The reason higher scars are more likely to open is that the upper segment becomes thinner during pregnancy, and the upper segment contracts hardest to "draw up" the cervix and expel the baby. Regardless of where the T part of your scar is, so long as it is as low as or lower than the low transverse incision i cannot see how it possibly makes any difference. I have a friend whose uterus was torn open to the inner os of the cervix during her emergency c-section (as stated above, they cut a bit then let the rest tear as they go, though AFAIK a "good" cut tends to only have 10-15% of the full length of the opening in tearing at each end, te vast majority SHOULD be the cut portion) and she has had 2 successful VBAC's, they just monitor carefully (though intermittently - she uses a private midwife and births at home) during transition when her scar is under most pressure.

The thinness of the scar seems to becoming a way to assess risk in Europe. In many countries they do a 3rd tri scan to assess the scar (in the UK it's around 30weeks, in other places 34 or 36) and see how viable VBACing is. AFAIK in the UK less than 4mm thick scar at 30weeks puts you at risk of rupture (apparently more than 4mm and there's the same risk as a non-VBACer), less than 1.8mm and they go for a repeat ceasar. Will your scar be scanned during THIS pregnancy? That is far more relevant to the safety of this VBAC than the notes from your last pregnancy are.

Also my own midwife (independant, not NHS) did a HBA2C 2 weeks ago. Mama had one emergency section then a repeat because she'd "never be able to birth her huge baby". Needless to say, she got her 3rd, bigger than both the others, out no problem.

Also i note YOU called THEM about the T-shape - it would have been interesting to see what they said without your input on this matter. Afterall really it isn't your job to assess risk, only to decide if the risk you're given is worthwhile. I'd be interested in to what he points in regard to figuring out your risk factor - as far as i know there have been no studies on Low-transverse-plus-T section scars.

I'm not trying to put MORE stuff into your head to worry about hun, this must be a tough decision. I just mean if i was being told "5% rupture risk" i'd like to know HOW they were coming to that figure - after all you have to make a very important decision based on these numbers, you need to know where they came from. "5% in my opinion" is not necessarily the same as "5% according to this study", kwim?

And i wouldn't be worried about "it's you who takes the risk, not me" - i know a couple of REALLY good health professionals who say things like that, and it's mainly to stress that they will empower you but you have to step up to the responsibility of the decisions you make while empowered. Sadly a VBAC or VBAmultipleC *is* more risky than a normal birth, for some people only very very slightly so, for others significantly so. I used get really mad at the (i thought unsupportive) midwife who used to ask when i was planning DD's homebirth "you REALLY know what you're getting into?" but you know what, i did a LOT of research through my irritation with that woman, and i probably coped about 40% better than i might have because of that research. Ultimately every woman who gets pregnant and treads softly along the path to birth has risks to take, all of us. But in the modern system a lot seem to forget this and are shocked and dismayed when outcomes aren't perfect. I get from this guy's reputation he isn't saying "you shouldn't do this" but "make sure you're ready for this ride".

As to whether 5% risk (if it really is 5%) of rupture is not 5% risk of a dead baby. "Rupture" covers everything from a litte of the scar tissue opening to the baby coming right out into the abdominal cavity. Yes, babies can die in that situation, mothers can die, but the risk factor of 5% is NOT that of neonatal or maternal death. Just as if you had a 5% chance of being in an RTA, it might be whiplash and a loss of the no-claims bonus, or it might mean you and the kid in the car both die. If you were given a 95% chance of getting to your destination without being in an RTA would you take that risk?

You have really done your researc here, and you have found an excellent care-provider to help you. I believe in your butt! You can do this mama!

Bxx

[Indadhanu]

Oh babe xxx


Just think, he'd probably say the same thing about a c/s. These are the risks, you need to be aware of them and accept them. They ARE your risks, but remember that there always a risk with a VBAC/VBA2C, AND a risk with a c/s, either way you're going to need to be ok with taking them

[Fleur]

Well, MG said everything I was going to say

5% chance of rupture gives you a 95% chance of non-rupture. They are pretty good odds.
And as MG said, 'rupture' includes scar separation, not necessarily life-and-death.
I love the traffic accident analogy, very apt.

I think your ob is being persistent about you understanding the risks for a couple of reasons.
Firstly, it is his responsibility to make sure you understand them. That is giving the power back to you to decide what you want to do & the power to make an informed decision. You need to understand everything & to know about what you are doing, including the risks.
And then of course he probably needs to make sure you get the risks for legal reasons sad but true.

does he just say yes to everyone wanting a VBA2C provided they understand the risks and are willing to take them?????????

You have to be willing to take those risks it's not a decision he can make for you. If you are a bit iffy on it all that might impact your chances as much as anything else. You need to accept it all in order to be able to trust in yourself that you can do it IYKWIM?

Ultimately you need to feel comfortable with what you are doing. There's time yet to read & take it all in. a big decision to make but you can do it!

[~mamaspice~]

Paradise Lost, I'm with you, I would have thought as long as the incision was in the lower uterine segment that it wouldn't have really increased the risk.

[mykids]

Thank you to for all the new posts

Thanks for your post Paradise Lost it made me see things differently. I actually never thought of it that way that the 5% includes all scenerios not just the really bad life and death so thank you for putting that in perspective. I thought I was thinking clearly but I guess not. Yes I have tried to imagine it in terms of the chances of having a car accident and for some reasons this just scares me more and feels like it is just all up to me to make the decision and if I get it wrong its all my fault.
I have DP opinon and he is of the attitude that I would be pretty unlikely for something to go wrong but he always thinks like that. I tend to think doom and gloom first which is really not helpful.
From what I have read I agree about what you say that an extra incision shouldnt make much difference particularly being in the lower segment but as Lesha has also pointed out he would probably say the same thing if I walked in and asked straight away for a cs - hit me with all the risks. I didnt think of it like that either so thank you again for giving me clarity and perspective. I guess I need to remember that a cs is very risky to me also. At the end of the day I need to remember that I am wanting a VBA2C for so many reasons and I do believe they are all valid and not selfish reasons.
Yes I have thought that he is just covering himself like Jasp said.

Thansk again everyone all of your posts have really made me feel a bit better and has definitly camled me down and I feel I am neary back on track. The encouragement to continue with my quest to VBA2C has been really needed so thanks

I guess this rollarcoster for me will continue for a little longer but I do think I will be more direct with Lionel next time and tell him exactly how I feel.

[mykids]

Oh and I am going to ask about scaning my scar later in the pregnancy and other bits to see how they are going. I do recall reading somewhere though that it is not very accurate but I will ask if he does it.

[MummyTummy]

You have Vaginal Lionel as your Ob. You are in great hands. But like all Obs, they have to tell you the risks involved because only you can take responsibility for your decision. If he just turned around and told you were having a c/s - end of story he could potentially be sued by you for not explaining your options and letting you decide what you want - for taking your rights away. So to me, the fact that he is giving you the risks, is happy to go ahead if you want shows that he is a good Ob and giving you the choice.

If you really are concerned about making the decision without his opinion, ask it. But don't act solely on his opinion, just put it in your decision file and weigh all the info up. You will know what is right for you when you have all the info at hand.

Goodluck in your decision!