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Opinions please

3ltlones3ltlones member
in VBAC

Hello.  My situation is a bit different.  I have had 3 vaginal deliveries, in 2009 I had myomectomy surgery to remove a 16cm fibroid from my uterus.  When they went in they had to cut vertically on the inside, outside cut is a traditional csection cut.

I was at the doctor yesterday and he said that there is a risk but it isn't a high one, up to 9% of uterine rupture.  He thinks that I would be fine though based on how things look now.  He is not allowed to suggest it based on office policy, they also want me to have the csection at 37 weeks, again hospital policy.  I have already started some progress, 1.5cm, short and soft and he can feel the baby's head.  He is hoping I can be there and be 6cm so that I can go ahead and do the vaginal delivery. 

So, I was wondering what your opinions were on trying vaginally, if I am able?  I wouldn't want something terrible to happen but I wondered if anyone had experience with this type of situation.

 

Thank you. 

DD(9)DD(5.5)DS(3)DS(born 2/1/11) July 2006, lost a baby at 8 weeks, natural miscarriage , May 2009 lost Zoe Eliana at 17 weeks no reason known, possible under developed organs. Lost two more babies in September 2009 at 7 wks 4 days. Had myomectomy surgery to remove a large fibroid in November 2009.
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Re: Opinions please

  • iris427iris427 member

    First, what do you mean by it's hospital policy to do a c/s at 37 weeks?  Not 39?  Is this specific to someone who's had a myomectomy or is that for all scheduled c/s moms?

    It sucks that your doctor thinks it's safe for you to deliver vaginally but has his hands tied.  Can you talk to him more about your options and if there is anyway around those policies?  Where on your uterus is your vertical incision?  There are some studies on women who have had low vertical cesarean incisions being good candidates for VBAC but I don't know how relevant that is to your situation.  A high incision is more likely to rupture.

    Also the 9% rupture risk sounds quite high.  I would ask your doctor if he is getting that number from a medical study or if it's just a guess.  I don't think I would be comfortable with a rupture risk that was that high.  For VBAC, the risk is usually under 1% for low transverse incisions, to put it into perspective.

    I think you really need to talk this over with your doctor more and see what is realistic, given your situation and the issues with the hospital and office policies. GL to you! 

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  • 3ltlones3ltlones member
    imageiris427:

    First, what do you mean by it's hospital policy to do a c/s at 37 weeks?  Not 39?  Is this specific to someone who's had a myomectomy or is that for all scheduled c/s moms?

    It sucks that your doctor thinks it's safe for you to deliver vaginally but has his hands tied.  Can you talk to him more about your options and if there is anyway around those policies?  Where on your uterus is your vertical incision?  There are some studies on women who have had low vertical cesarean incisions being good candidates for VBAC but I don't know how relevant that is to your situation.  A high incision is more likely to rupture.

    Also the 9% rupture risk sounds quite high.  I would ask your doctor if he is getting that number from a medical study or if it's just a guess.  I don't think I would be comfortable with a rupture risk that was that high.  For VBAC, the risk is usually under 1% for low transverse incisions, to put it into perspective.

    I think you really need to talk this over with your doctor more and see what is realistic, given your situation and the issues with the hospital and office policies. GL to you! 

    Thanks for your reply.  The 37 weeks is particular to my situation because of the myomectomy.  I'm not sure if that is specific to my office or hospital or if that is a general rule for myomectomy surgery.

    My vertical incision started just below the belly button and then down. The 9% is up to 9%, starting at 4% and it's from a medical study, but the study shows that that risk does not increase at all during labor and actually starts to become a risk at 28 to 34 weeks when your uterus becomes a certain size.

    I do have a call into him now and have a lot of questions that I will be asking, that I forgot to ask yesterday.  If there will be close monitoring and I can be brought into a c-section if there are signs of  problem, I'm leaning towards the vaginal delivery but I want to make sure I have all of the information first.

    Thank you again. 

    DD(9)DD(5.5)DS(3)DS(born 2/1/11) July 2006, lost a baby at 8 weeks, natural miscarriage , May 2009 lost Zoe Eliana at 17 weeks no reason known, possible under developed organs. Lost two more babies in September 2009 at 7 wks 4 days. Had myomectomy surgery to remove a large fibroid in November 2009.
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