C Sections and following pregnancies

AnthonyTheEmt

AnthonyTheEmt

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Hey, I was recently told by a patient who's last pregnancy was a c section that her doc told her any pregnancy after that had to be a c section as well. My best guess was maybe because the uterine muscle has been cut, despite healing it could present a problem in the future. Does anyone know anything about this or if its even true??
 
Search for the term "VBAC"
 
A female with a history of cesarian delivery has a greater chance for uterine rupture for ways you've already mentioned... The scarring also leads to a higher chance of a low riding placental attachment, or placenta previa, and can also lead to greater chances of increased PPH, among other complications already present for the multiparous patient.
 
AnthonyTheEmt said:
Hey, I was recently told by a patient who's last pregnancy was a c section that her doc told her any pregnancy after that had to be a c section as well. My best guess was maybe because the uterine muscle has been cut, despite healing it could present a problem in the future. Does anyone know anything about this or if its even true??
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For the most part, yes it is true. There are some instances where a vaginal birth can be attempted after a c-section delivery, but it would be very difficult to find a physician who would risk it.
 
There is also evidence that the risks are greatly over exaggerated and that the idea that once a woman has had a c-section she must always have a c-section was part of the drive to encourage more c-sections.
 
Veneficus said:
For the most part, yes it is true. There are some instances where a vaginal birth can be attempted after a c-section delivery, but it would be very difficult to find a physician who would risk it.
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Just finished 8 weeks of OB and we TOLAC (Trail of Labor After C-section, VBAC isn't used much anymore) nearly everyone...the risk of rupture is around 1%. There had to be a very compelling reason to section a patient if the only "indication" was previous section.
 
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Dwindlin said:
Just finished 8 weeks of OB and we TOLAC (Trail of Labor After C-section, VBAC isn't used much anymore) nearly everyone...the risk of rupture is around 1%. You can't throw a cat in this area without hitting an OB who WILL TOLAC his patients, better for everyone involved.
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sounds great
 
Dwindlin said:
Just finished 8 weeks of OB and we TOLAC (Trail of Labor After C-section, VBAC isn't used much anymore) nearly everyone...the risk of rupture is around 1%. There had to be a very compelling reason to section a patient if the only "indication" was previous section.
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I wish more place were like this. My doctor threatened me with a scheduled c section from the beginning because I was G6. The csection culture of ob drives me crazy.
 
For anyone interested, 2006 article from Obstetrics and Gynecology relating the risk of rupture in TOLAC.

http://www.ncbi.nlm.nih.gov/pubmed/16816050

Edit: Should also point out we do nearly 100% Low-transverse sections here, which better allow for TOLAC later, in fact in 8 weeks the only "classic" section I saw was a peri-mortem on a trauma patient. The way you are cut matters.
 
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Dwindlin said:
For anyone interested, 2006 article from Obstetrics and Gynecology relating the risk of rupture in TOLAC.

http://www.ncbi.nlm.nih.gov/pubmed/16816050

Edit: Should also point out we do nearly 100% Low-transverse sections here, which better allow for TOLAC later, in fact in 8 weeks the only "classic" section I saw was a peri-mortem on a trauma patient. The way you are cut matters.
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You read my mind.
 
A friend has had 7 babies vaginally, after her first one was C-section. So no, it doesn't mean anything
 
Dwindlin said:
For anyone interested, 2006 article from Obstetrics and Gynecology relating the risk of rupture in TOLAC.

http://www.ncbi.nlm.nih.gov/pubmed/16816050

Edit: Should also point out we do nearly 100% Low-transverse sections here, which better allow for TOLAC later, in fact in 8 weeks the only "classic" section I saw was a peri-mortem on a trauma patient. The way you are cut matters.
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And even knowing this, we approach the whole thing with negative language: TRIAL of Labor? As in "go ahead- try!"

Everybody knows that there is "do or do not, there is no try."
 
abckidsmom said:
And even knowing this, we approach the whole thing with negative language: TRIAL of Labor? As in "go ahead- try!"

Everybody knows that there is "do or do not, there is no try."
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I thought the same thing. I've got an image of a condescending OB/GYN saying "Well, we'll let you go ahead and try for a little bit....".


I think VBAC is a better term.
 
Thanks for the feedback. I thought it was odd that she said her doc said all following pregnancies had to get a c section. I googled VBAC and the article said theres about a 10% (at the most) of having a uterine rupture s/p c section
 
Aidey said:
I thought the same thing. I've got an image of a condescending OB/GYN saying "Well, we'll let you go ahead and try for a little bit....".


I think VBAC is a better term.
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Admittedly, I'm pretty biased. I think that the OB industry in this country is so completely disrespectful to women and families. I hate decisions made for litigious reasons.
 
Besides, a Toe Lac gets stitches. It's a stupid acronym.
 
I don't even have kids and I think the OB industry is whack. But I also can see why, when some states allow the OB/GYN to be sued until the kid is 17 years 364 days old. Or when states allow both wrongful death and wrongful birth suits. People refuse to accept that nothing goes right 100% of the time, and it is impossible to have 0% complication rate. There is a reason OBs have the highest insurance rates in the nation.

That all being said, some of the people on far other end of the spectrum are a little nutty too. I once had a midwife who talked a family out of transporting their newborn that had just needed BVM resuscitation. We all started backing out slowly as she started ranting about industrialized medicine.
 
For anyone that thinks the OBs are wrong in their overly defensive decisions I'll tell a little story I witnessed on my time on L&D. Women comes in, has been laboring at home for several hours, came in because a CNMW insisted it had been too long. She comes in, refuses all care, initially. She was told MULTIPLE time by myself, the nurses, the residents, and the attending that she was endangering her baby. Couple more hours go by, she has not progressed, we finally convince her to let us just put a HR monitor on. FHT in the 60's. She refuses emergent section, labors for several more hours, finally delivers a previously healthy, deceased fetus.

Immediately begins yelling that no one told her the risks, etc, etc. Attending was served my last week on the rotation.

Now, will she win? I truly hope not. But even if she doesn't "win", this attending has to take time off work, hire a lawyer, a deal with the stress of a lawsuit. Then there is the chance that his malpractice could just settle if they decide the case isn't worth taking to trial, no big deal right? Wrong, that goes against the physician even if he has no say in the matter, because for the malpractice carrier it is purely a monetary decision.

Now, these scenarios aren't as uncommon as people believe, and they exist in every specialty in medicine. So as much as it pains me to see some wasted decisions and entirely overly conservative decisions made by docs, believe me I get it.
 
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