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    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    Jun 10
    2010

    Natural Birth after Laproscopic Myomectamy

    Archived User

    I had a myomectamy in March 2009. All of the fibroids removed were outside of the uterus, and at no time was my uterus cut all the way through. One intermuscular fibroid at the top of my utereus was no removed. I became pregnant 3 months later. Unfortunately, that pregancy ended in a premature labor and stillbirth at 23 weeks.  My sense of that, is that the baby was not well and ended th pregnancy. Six weeks later, I became pregant again. I am not 24 weeks and both baby and I are healthy, and this pregnancy has been noticeably better and easier. During both pregnancies my fibroids returned . I am 37 years old, and I have been relagated to a high-risk clinic because the birth center would not take me. I am VERY committed to a vaginal birth, but the obstetricians at the clinic are skeptical. We are currently in a "wait and see" attitude, but I fear I will be fighting an uphill battle.

    My question is...what REALLY are the risks of vaginal birth after the myomectamy. Is it similar to VBAC? I was told it depends on whether the scarring was up high on my uterus. Would this really matter if my uterus wasn't cut through? Do you know of doctors in Tucson, AZ who might be more open to letting me try a natural vaginal birth? I am not completely opposed to a c-section if, as we get closer to the birth, the baby is having trouble or I don't dialate, etc., but I am frustrated with the attitude of not even being willing to try. Am I just being too stubborn? Are the risks much higher than I understand, or are the doctors just following protocol regarding of my individual situation?

    Henci Goer

    As a general rule, having uterine surgery puts you in a higher risk category than women with an unscarred uterus, but, as you yourself are wondering, is the risk moderated by the site of the fibroids and whether they were internal or penetrated the uterine muscle completely? And my apologies, but I have not researched complication rates with labor after myomyectomy.

    If I could sum up your issue, it is assuring yourself that you can trust your care providers' advice and judgment. A quick way to determine this is to ask two questions of them: What is your cesarean rate? and What is your vaginal birth after cesarean (VBAC) rate? If the former number is much higher than 15%, the maximum recommended by the World Health Organization based on the research, or they can't give you at least a ballpark figure, you will know that you can't trust their judgment when it comes to advising you. Turning to their VBAC rate, they should encourage VBAC and have VBAC rate in the mid 70% (3 out of 4), a percentage likewise based on research. You have not had a cesarean, of course, but, again, their attitude toward VBAC and their practices will tell you whether you can trust their judgment. You will have to ask them all because practices may vary.

    If the answers you get are unsatisfactory, here are some suggestions for how to find another care provider: Go to the Birth Survey and see who is recommended in Tucson. If that doesn't help, see if there is a Birth Network or International Cesarean Awareness Network chapter and see who they recommend as progressive care providers.

    As you grapple with your decision, it is important to know the risks of planned cesarean surgery, not just the risks of planned vaginal birth. The Coalition for Improving Maternity Services has a fact sheet and informed consent form on this.

    Please let me know how things turn out for you.

    -- Henci


    All Times America/New_York

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