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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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    Oct 20
    2010

    VBAC with a Classical Incision

    Archived User

    Hi everyone,

    I am so distressed I am digging and digging for promising news somewhere! Two months ago I had a classical c-section with my 27 week old son. The placenta was bad and he was dying and everyone insisted that it had to be a classical. I fought them as much as I could but they said labor would kill him because of the pressure on the placenta and that because he was premi, it had to be a classical. My son passed away after he was born and I've spent months recovering from this miserable surgery. I've had three prior vaginal deliveries that were about an hour or so long and required no pushing. We wanted a large family and now every doctor in the area is insisting that whatever we do, we would DEFINITELY have to schedule another c-section because I would most likely rupture and our next baby would die. I don't want to lose anymore children but everything people are telling me just doesn't feel right. I don't think I could ever voluntarily go through that again when my body does labor so well! I am devastated at losing my son but I also feel lied to about having a classical. I am sure it didn't HAVE to be that way, but what are you supposed to do when your son's life is on the line? I've read so much research on VBACS but I never know if it pertains to a classical since I think almost no one has a classical anymore. I would appreciate any research, advice, support, or stories that are out there to help me out. What are the chances of my scar REALLY rupturing and the baby dying? Why can't I find anyone who will do a vaginal birth for me? Do I really have to wait a year and a half for everything to truly be healed? What is the REAL information on classical scars? I'm fairly desperate to hear anything that I can. Thanks!

    Archived User

    I forgot to add that I have triple sutures on the scar. My spontaneous labors were all at 38, 36, and 37 weeks and all of my babys were under 6 lbs 11oz. Aside from this one pregnancy, all of my pregnancies have been perfect and easy.

    Henci Goer

    First of all, let me say how sorry I am for your loss. I can appreciate, too, how  terribly difficult the decision must have been for you. I hope you will find some comfort, though, in knowing that it is often not possible to do the usual transverse incision with a very preterm delivery because the lower segment of the uterus isn't sufficiently developed to permit one. That being said, you should clarify with your obstetrician whether a low vertical incision was performed or a true classical vertical incision. The low vertical incision is more common in cases of preterm delivery and according to the research, it is no more likely to give way than a transverse incision (98.5% to 99% chance of no problem). If, in fact, you do have a true classical vertical incision, everyone agrees that risk of the scar giving way during labor is higher than with a transverse incision, but we don't have much data on how high that risk is. The best I have found is the rate in a (relatively) small number (105) of VBAC labors in a mixed group of unusual incision types--classical vertical, T-shaped, J-shaped. The rate was 2%, or 98% chance of no problem, but no information is given on how many of those women had classical incisions. Let me add, too, that scar rupture does automatically mean the baby will die. Five percent of scar ruptures result in death, which is far from negligible, but which also must be weighed against the risks to you and to any future babies from accumulating repeat cesarean surgeries. These are not negligible either. Finally, if you are planning more pregnancies, yes, it is a good idea to allow your uterus to heal completely before becoming pregnant again, but this isn't a huge amount of time. Two years between births is sufficient. Finally, the fact that you have had prior vaginal births works strongly in your favor as a VBAC (vaginal birth after cesarean) candidate. Women with prior vaginal births are much more likely to birth vaginally and less likely to have problems with the scar than women who have not, which may offset some of the increased risk with the vertical incision, if it is a classical incision.

    ~ Henci

    Guise JM, McDonagh M, Hashima JN, et al. Vaginal birth after cesarean (VBAC) Report/Technology Assessment No. 71. Rockville, MD: Agency for Healthcare Research and Quality March 2003. Report No.: AHRQ Publication No. 03-E018.

    Landon MB, Hauth JC, Leveno KJ, et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med 2004;351(25):2581-9.

    Lieberman E. Risk factors for uterine rupture during a trial of labor after cesarean. Clin Obstet Gynecol 2001;44(3):609-21.

    Sciscione AC, Landon MB, Leveno KJ, et al. Previous preterm cesarean delivery and risk of subsequent uterine rupture. Obstet Gynecol 2008;111(3):648-53.


    All Times America/New_York

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