Want to have a successful VBAC (Vaginal Birth After Cesarean) if you must have a C-section the first time around? Read on!
When it comes to giving birth, a vaginal birth is certainly preferable to a C-section. Recovery from vaginal birth is much more rapid and involves less danger to the life of the Mother and child. After all, a C-section is considered major abdominal surgery with all the inherent risks.
In addition, there is evidence that children born vaginally are healthier than those born by C-section. Vaginal birth allows the child’s sterile gut to have first exposure to beneficial flora from the Mother during delivery. This exposure helps to properly seed the intestinal tract with immune system boosting bacteria.
Birth by C-section initially seeds the child’s gut with whatever bacteria are floating around the hospital environment. This leads to a higher risk for development of auto-immune problems. These chronic issues include allergies, leukemia, type 1 diabetes, asthma and others.
Intravenous (IV) antibiotics during labor can also negatively affect the normal seeding of baby’s gut during vaginal birth. As a result, skipping the Strep B test is a good idea since women who test positive are frequently forced to have IV antibiotics. Unfortunately, this happens even though research has failed to demonstrate any benefit to antibiotic treatment during labor.
Another benefit of vaginal birth is that it involves a gradual and more tolerable increase in stress for the baby. This as opposed to a cold cut Cesarean which shocks and stresses the newborn in a very short period of time. The shock stress of a C-section potentially causes unfavorable DNA changes to the baby’s white blood cells (July 2009 Acta Pediatrica).
For these reasons, it is best to take steps to avoid C-section if at all possible. Having a natural birth at home or at a birth center and avoiding an epidural is one way to reduce C-section risk. Another is to know how to induce labor naturally if baby is late.
In addition, planning for future pregnancies to be VBAC is wise too. Planning for a natural birth with a midwife in attendance with avoidance of all drugs definitely helps skew the odds in Mom’s favor. One intervention typically leads to another, and then another. A domino effect to C-section is thus avoided by refusing all interventions unless deemed a medical emergency.
Sometimes, despite everyone’s best efforts, a C-section needs to be performed. In these situations, C-sections are indeed a life saving operation.
The fact is that life is unpredictable and a C-section is the end possibility for every pregnant woman. This is true no matter how much planning is done to prevent one! As a result, every pregnant woman needs to have a conversation with her OB about the approach to stitching up the uterus in the event an emergency C-section is necessary.
Successful VBAC and Uterine Sutures
Many parents do not realize that the doctor performing the C-section has a choice about how to stitch up the uterus following surgical birth.
Double Layer Suture
The double layer uterine closure was primarily used throughout the United States prior to the early 1990’s. The first layer of sutures pulls all the cut edges of tissue together. The second suture layer, called the “imbricating pattern”, pulls uncut tissue together on top of the first suture layer.
Single Layer Suture
The single layer uterine closure has been used since the early 1990’s in the United States. Europe also uses this technique extensively. It involves suturing the cut edges together. Then, smaller sutures are used to stop any continued bleeding or to pull together areas of tissue that aren’t well counterbalanced.
Which Type of Uterine Suture is Best for a future VBAC?
Overwhelming evidence has shown that the single layer closure involves fewer complications in the immediate post operative period.
Research has also indicated that the double layer closure involves less risk of uterine rupture and successful VBAC with future pregnancy.
In other words, each suture method has benefit as well as a downside.
In 2002, a large study was published comparing single to double layer Cesarean sutures. A significantly higher risk of uterine rupture with the single versus the double closure (3.1% vs. .5%) was identified. The study analyzed 489 women who had C-sections with the single closure and 1491 women with the double closure. Results were controlled for use of pitocin, epidurals, age, and other factors.
The study authors concluded that the single closure method involves significantly higher risk of uterine rupture if the woman attempts a VBAC with a later pregnancy.
Since this study, prominent midwives in the US community have advocated use of the double layer closure to improve the odds of women attempting VBACs. Some even believe that women who have had a single layer closure should not be allowed to plan out of hospital births or VBACS at all.
I heard a prominent US midwife interviewed on National Public Radio advocating the double layer closure. Her reason? This type of suture is a very good idea for women who desire a successful VBAC with future pregnancy.
Smaller studies have shown no difference in risk of uterine rupture between the two suture methods. But, the overwhelming results of the large study by Bujold remains a concern for many in the midwifery community. Hence the continued push for use of the double layer technique.
VBAC Conclusions
If a Mom is only going to have one child or her current pregnancy is her last, then the single layer closure is probably the best choice. This type of suture in the event of a Cesarean gives the best chances for optimal post operative recovery.
However, if Mom wants more children and wants to birth them vaginally, insisting on the double uterine closure in the event a C-section is best. This type of suture greatly improves her odds for a successful VBAC in the future. In fact, some OBs and midwives won’t even attempt a VBAC without it.
Sarah, The Healthy Home Economist
Source: The Suture Debate
I had a elective, scheduled c-section (for a believed-to be macrosomia baby) and it was pretty darn easy! Uncomfortable for a bit, but I was back to walking within a day, driving within 3 days, etc.
So my question is: since vaginal births come with their own set of post-birth discomforts, what would the real benefit be to going vbac? I’d love to have another but am curious as to why I wouldn’t just have a c-section with the next one too?!?
P.S. I was a 12 lb baby, and big healthy babies run in our families…so that might be part of my hesitancy to ever try a vaginal birth. 😉
I have had 2 successful vbacs with the first in 2011. My c section was in 2009 and the OB specifically told me that she did the double closure so that I would be free to try for a vbac the next time around. I didn’t know back then how important that was to hospitals when I went for my vbacs in Asheville. Planning on a birth center or home birth if we ever have another.
I had a successful VBAC in 1999. No idea what type of sutures I had for my 1995 C. I do know today doctors and hospitals are trying very hard to stop VBACs. Hiring a doula is a great idea.
Hmm? C-sec 1992 and 3 v-bacs after at home. My ob was an older man…can’t tell you what kind of sutures I got but, I knew I was done with the invasive hospital ideas 😉
Midwives rock
This certainly makes a lot of sense. As we all know the medical community doesn’t always do what makes sense usually has something to do with what your insurance company or what the Dr is concerned with because of the high malpractice insurance rates it’s more than a technique or accepted practice. I think it has more to do with legal issues and fear on both sides.
I’ve never heard of either. I had a csection. I wonder if I had a single or double closer. Maybe I can call the hospital and see what is the most performed method there.
Interesting – #’s 1,4,8 and 9 were C-Sections and 2,3,5,6,and 7 were VBACs – (my 3rd C-Section was to deliver a 12lb baby with a birth defect – after that they wouldn’t even consider a VBAC for my 9th child -however the doctor said my uterus looked fine and I could have more children if I liked.
I haven’t noticed a difference in health for any of my children – they are all extremely healthly – thank God. We do have some allergies but that crosses the “how I was born” line and both vaginally delivered and c-section children have them. I do agree 1000% that a vaginal delivery is much easier to recover from BUT as we all know the life of the baby and the mommy are utmost important and neither I nor any of my children born by C-Section (except the last one who I was forced to have that way) would be alive if a c-section wasn’t used.
Love this article. I had a c-section in 2008, and was single sutured. I had a HBAC (home birth after cesarean) in 2010 that ended in a hospital transfer and another c-section. I insisted on a double suture despite their recommendations against (or laziness – who can be sure?). In my experience the recover was easier the second time. This morning I had a large fibroid removed, as that may likely be the reason I needed the c-sections since it’s large and contributed to malpositions that made descent very difficult. Hopefully I’ll VBAC successfully if we are blessed with #3.
Anyways, the only point in this article I disagree with is that a woman should only insist on a double suture if she plans on having more children. All of us know how many children are unplanned. Better to be safe than sorry. Insist on being double sutured. You never know how your plans may change.
Cheers,
Jessica
Good point Jessica. Many of our little blessings are unplanned!