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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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    Feb 03
    2011

    VBAC after failed assisted delivery?

    Archived User
    Hi Henci,
    I recently had my first child. I spontaneously went into labor at 40weeks 2days. I never needed augmentation and my water broke on its own. I pushed for four hours before we attempted forceps. They did not help. I just could not get him past the pelvic inlet. I ended up with an inverted t incision on my uterus, and my son was 8lbs 14.4oz What chances do I have at a successful VBAC? Is my pelvis just too small? How high are my chances for uterine rupture? I think my son was OP. I had terrible back labor and after all that pushing he did not have a cone head.
    Henci Goer

    I can't give you anything exact. I can tell you that persistent occiput posterior position (baby facing the mother's belly instead of her back) is a much bigger factor in cesareans than baby's size. If you are right, and this was the problem, you might have no difficulty pushing out an even bigger baby, but if you have another OP baby, the same thing might recur. Still, that isn't necessarily a reason not to plan a VBAC, just a possible reason to throw in the towel sooner if it does. So far as size goes, way too many women have gone on to birth bigger babies in VBAC labors than the baby they couldn't birth the first time to make any hard and fast rules about size ruling out VBAC. So, yes, your odds for VBAC are lower than they would be if your cesarean had been for a nonrecurring reason such as breech or fetal distress, but they are better than 50:50 even so. When I looked at the VBAC research, I found that studies reported VBAC rates of six out of ten or more in women with factors that diminished their odds.

    Frankly, if you want to plan a VBAC for your next birth, the inverted-T incision is likely to be an obstacle. We don't have much data on how inverted-T incisions behave during VBAC labors compared with the more usual horizontal incision, and given how skittish most obs are about doing VBACs at all, you are might find it difficult to find one who will agree even though we have no reason to think they are more problematic.

    I hope you are recovering well emotionally as well as physically, It sounds like your labor was a difficult and disappointing experience. 

    ~ Henci

    Archived User

    Henci,

    Thanks for the information. I am looking for OB doctors and it has been an obstacle. (I am not pregnant just thinking ahead) I have found some possible midwives to do a homebirth.. I am just afraid that if I found an OB that agreed to take me on that they would be so skittish all the monitoring may lead to a possibly unwarrented c-section. So I guess I will move to the homebirth/birthcenter forum and see if I can find any that take on inverted T's I really believe I can have a better birth experience next time. Also thought I would mention my hospital just had some studies done and our c-section rate is 49%

     

    Henci Goer

    I am horrified by your hospital's cesarean rate, but I am not shocked. I wish I could say I was, but rates in this range are becoming all too common.

    You are right to be concerned about unnecessary strictures should you even find an ob willing to attend a VBAC with an inverted T uterine scar. I just read an analysis of cesarean data between 2002 and 2008 from a consortium of 19 U.S. hospitals, 17 of them academic or teaching institutions. The VBAC rate in women planning VBAC was a dismal 57%. Numerous studies have shown that a rate of 75% or more can be achieved in an unselected population.

    I wish you all the best in your quest.

    Zhang J, Troendle J, Reddy UM, et al. Contemporary cesarean delivery practice in the United States. Am J Obstet Gynecol 2010;203(4):326 e1- e10.

    ~ Henci

    Archived User

    Hello ladies!  Having a VBAC after an Inverted T can be done!  Finding a good care provider is the hardest part.  Have a look at the info at http://www.specialscars.org and email me (info on the site) for help finding a care provider.  There are a handful of doctors and midwives that will asssist.  There are a bunch of us on the Yahoo group who have VBACd.  :-)

    According to the Landon study (the sample was small but still he noted it) the rupture rate after an inverted T was 1.9%.

    Much luck on your journey!

    Jessica
    Student midwife, mom to 4 girls and 1 boy
    Ask me about my 2 VBACs after Inv T!


    All Times America/New_York

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