? for those who have had successful vbac or plan to have one

sugarbabee · January 2012

I am planning a vbac in May after a c-section for a breech baby back in 2008. I recently read somewhere that double stitching of the uterus after c-sect is safer then a single layer of stitching. So after reading this I made sure to ask my ob if I had double or single layer stitching w/ my c-sect. She had told me double stitching but said they used a cheaper form of sutures then what she would have used, and said it obviously held so not to worry. I am trying not to worry but it scares me. All I want is a healthy baby. Anyone know anything about this or anyone know how they were stitched after c-section?

selockar · January 2012

I can see why that could make you worry a little. If your OB isn't concerned, it's probably best to just put it out of your head. I am sure your OB wouldn't want to do anything to make your VBAC risky. You could also get a second opinion, if you think it will help ease your mind.

MAprincess · January 2012

The stitches aren't there anymore. What she means is that you clearly healed. So it is not those stitches holding things together anymore. If your doctor is not concerned, I don't think you should be either (easier said than done, I know!)

I know I had the double layer stitches with my c/s.

sugarbabee · January 2012

Oh of course I know they aren't there anymore. I just read an article about layers of stitches and uterus rupture statistics after c-section. I just thought it was interesting to discuss. The more knowledge and support the better.

hopecounts · January 2012

It's the fact they did two layers that matters. That promotes a better healing and makes things stronger and that makes it safer. At least from what I understand.

holly321 · January 2012

I had the double layer, but I had to have the chromic catgut, which is considered to be the inferior form of sutures, because I am allergic to vicryl.

But like pp said, the double layer is what matters more.

rbytsdy · January 2012

The single vs double layer suture issue is debatable, at best. My guess is that you have a double layer suture made of chromic catgut. The studies comparing single vs double layer sutures were done years ago and mostly compared single layer chromic vs double layer chromic. Those studies showed that double layer chromic sutures had fewer URs than single layer chromic sutures. Today doctors tend to use Vicryl which has a higher tensile strength. Ethicon (a J&J company that makes the sutures) is trying to decrease chromic sales/usage but some doctors still like it.

There are actually only 2 studies that show a higher rate of UR in single layer sutures. They had higher rates of UR overall (over 1% while most well-done studies show UR rates below 1%).

However, it?s important to keep in mind that there is more to uterine rupture risks than suture material. There is suture technique (how the stitching was done and whether it?s in a locking or non-locking pattern). There is also surgeon skill which is tough to study.

Also, the studies that show higher rates of UR in single layer studies included a lot of pitocin and a lot of inductions ? both factors which are known to increase UR. One study should actually be thrown out for using cytotec (known to cause UR in non-scarred women) and only including 35 women in their single layer group as opposed to 948 in the double layer group. The cytotec and surgeon skill (doctors not as comfortable with single layers) almost certainly played a roll in the UR risk with that study.

FWIW, there are a least 5 studies that show no difference in the rate of UR in single vs double layer sutures (or the single layer had few ruptures). Single layers have been shown to have fewer infections and faster recovery time (which makes sense; if you are open for less time, you have less chance of infection).

So rest assured that studies show you have a good suture. But women with single layer sutures really shouldn?t panic since there are other factors that come into play.

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Nov5Mrs. · January 2012

For what it's worth, since we were thinking about trying for #3,I asked my OB (who did not perform either c-section), she looked in my chart and said that for my 1st C-section I had double-layer and my second I had single. She's supportive of VBA2C (should I get pregnant), and said not to worry about single v. double layer.

iris427 · January 2012

I really wouldn't worry about this. I have no idea what kind of suturing was done during my c/s and my VBAC doctor never mentioned it at all. He was more interested in what type of incision I'd had, how long ago my c/s was, and what the circumstances of my c/s had been. I had a VBAC with no complications.

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