Hi Henci!  Thank you for providing this resource.  I got in touch with Amy Romano after reading the guide to the new NIH recommendations and she suggested I put my question to you.

Four months before I got pregnant with my first, I had an intrauterine fibroid removed via abdominal myomectomy.  I don't know exactly where the fibroid was (I could find out fairly easily, I think); I do know it weighed close to a pound.  Because of this prior surgery, my OB (who is in the same practice as the doctor who performed the myomectomy) recommended a C-section.  I talked to her tentatively about a vaginal birth and her answer was, in essence, "If the fibroid had been smaller or in a different place, we could consider it, but not with what you had."

I tried doing research on post-myomectomy vaginal birth but found very little.  Even very pro-VBAC sources I found (a book of Ina May Gaskin's, for example) had nothing about prior non-C uterine surgery.  To make a long story short, my daughter was born by planned C at 39 weeks.  (And compared to the myomectomy recovery,  the C recovery was a breeze!)

I'm not pregnant now, but we're considering having a second child sometime in the next few years, and I'd like to go into that pregnancy more informed about VBACs and my situation than I was the first.  My initial reading about the new recommendations gave me hope that I would be a possible VBAC candidate even given the prior surgery (my scar is horizontal; it would be more than 18 months between births; I have a lot of choices for hospital care).  But reading about the higher risk of uterine rupture makes me think that even with the new guidelines, I am just not a good VBAC candidate.  But if you can point me to further resources or information, I would be very grateful.

Unfortunately, I can't point you to other resources because, as you have already discovered, there aren't any. All of the VBAC studies are of women with prior cesarean surgery, and even there, they are of women with a low transverse uterine scar or a low vertical incision (often used in preterm c/secs because the lower uterine segment is not well developed). I think your best bet would be to find an ob who is pro VBAC and have her or him evaluate your surgical records and give you an opinion. Depending on where you live, you may need to travel to do this because pro VBAC OBs are thin on the ground. Ways to identify such a person would be searching the Birth Survey website or seeing what the International Cesarean Awareness Network can provide, starting with whether there is a local chapter near you. 

~ Henci  

Henci, thank you so much for your reply!  Fortunately I live in a major city with a local ICAN chapter (whose site lists one pro-VBAC MD). 

I am going to hold out hope, since my OB made a point of saying she was able to "use" the previous incision to perform the CS (and the post-CS scar was smaller than the post-myomectomy scar).  Like I said, I've got some time before I have to make any decisions.

You're welcome. I'm glad to have helped. I would be interested to know what this OB advises--and FYI: if it should be a cesarean, the ICAN website has a page on planning an optimal cesarean.

-- Henci