What if? C-Section & Double Layer?

junie216

I was reading Ina May's book on childbirth last night, and it said that if you happen to need a c-section, you are supposed to ask for your uterus stitched up in two layers as opposed to one.

Can someone please explain this concept to me more?

 I tried Google and only found this:

Of 948 subjects identified, 913 had double-layer closure and 35 had single-layer closure. The uterine rupture rate [with VBAC I assume] was significantly higher in the single-layer closure group (8.6% vs. 1.3%, p = 0.015).

https://www.ncbi.nlm.nih.gov/pubmed/17118738

The Ina May book seemed to infer that Doctors now are learning only single layer closure methods?  What if I need a C-Section... how do I properly ensure I'm able to get a double layer closure?

AimnJus917

I can't answer your question, because I want to know too.  This is also stated in The Birth Partner which I just finished reading and so I put that on my birth plan - "if C-section becomes necessary, double sutures please"  I discussed with MW and she said, "I can't guarantee that because some OBs do it and some don't, based on the evidence they were taught/believe in."  She said there are arguments to both single and double sutures - double means more scar tissue (read: weak) and so it's not necessarily safer or more "sturdy" for a subsequent vaginal birth.  So I said - well I guess I don't really have a say in that one then. I'm just hoping it doesn't come to that!

sbevmc09

As far as I know it's pretty standard for them to do a double layer closure.  I'm not sure in what instance they would try for a single layer because it seems that that is clearly not a good idea! 

If I were you just talk to your care provider to see what they say about it.  I would imagine they'll tell you that a double layer is standard, but bring it up with them.  If you feel like you need to you could certainly write up an "in case of C/S" birth preferences list and you could include on that that you would prefer a double layer closure, also you might want to explore sutures vs. staples and that sort of thing.  

nosoup4u

I think it's fairly standard to have double-layer sutures, but you can always talk to your provider about it (especially if you're seeing an OB). Here's a good overview about how the evidence isn't super clear either way:

ican-online.net/resources/white_papers/wp_suture.pdf

I can't recall anyone on the VBAC board being given a hard time bc they had single-layer suturing. It might be worth asking over there, though.

iris427

I think this is more complicated than Ina May makes it seems. I wouldn't stress about this. Or you can ask your doctor what they think is best for someone hoping to VBAC in the future.

Mrs E in Oregon

My reading is that this is the cause of so many vbac uterine ruptures that changed ACOG's opinion on vbacs in the 90's. They started doing single layer to save costs and time and these are weaker because it is just one big stitch. The double layer is significantly stronger for the uterus because it isn't healed along one "fault line." Also, there is risk that your placenta will grow through this single layer scar and then you'll need surgery to remove the placenta, have excessive bleeding and other risks. I wish I could site this source but I don't remember which book from the library it was in.

In my birth plan I am requesting that if I have a c-section my midwife be present during the closing to ensure the best methods are used = double layer closure. I know that isn't necessarily going to happen but I can hope.

nosoup4u

Mrs E in Oregon:

My reading is that this is the cause of so many vbac uterine ruptures that changed ACOG's opinion on vbacs in the 90's. They started doing single layer to save costs and time and these are weaker because it is just one big stitch. The double layer is significantly stronger for the uterus because it isn't healed along one "fault line." Also, there is risk that your placenta will grow through this single layer scar and then you'll need surgery to remove the placenta, have excessive bleeding and other risks. I wish I could site this source but I don't remember which book from the library it was in.

In my birth plan I am requesting that if I have a c-section my midwife be present during the closing to ensure the best methods are used = double layer closure. I know that isn't necessarily going to happen but I can hope.

If your placenta is growing over a previous c/s scar, it doesn't matter how many times it's sutured, it's a high-risk pregnancy. https://en.wikipedia.org/wiki/Placenta_accreta

All the UR in the 90s were due more to induced VBACs not being done carefully enough, rather than everyone having single layer sutures.