Birth After Special Scars

What kind of scar do I have?

Without reading your surgical report there really is no way to know.  The scar on your belly may not match the scar on your uterus.  You can request your surgical report from the hospital where you had your c-section.  You usually have to do this in writing and they may or may not charge you for the copies.

While you are reading your surgical report look for any notes about your incision.  Look for any measurements that may have been included, how high the vertical segment of the incision went, if you had one, if it went up or down, if it was in the middle or at one end or the other.

An important note to remember about VBAC is that once upon a time, the women who fought for and changed the right to have a trial of labor were all “Special Scars,” they were mothers with classical and other vertical incisions because all cesareans were done that way. Those women were the forerunners of today’s women of VBAC and they did so successfully.

Classical – A classical incision is a vertical incision in the upper segment (extending into the fundus) of the uterus, this was the incision that was most used when they first started doing cesareans.  All of the original VBACs were on classical incisions.  It is not used very often anymore, except on very premature babies or in extreme emergency situations.

Inverted T – An inverted T incision usually begins with the doctor making the low transverse incision and then adding a vertical incision for whatever reason up the center of the uterus, usually because the baby is stuck in an odd position.  The length of the vertical portion varies.

J – An incision that looks just like a J, the doctor may have started out with a low transverse incision and then added a vertical incision up the side of the uterus, usually done for the same reasons as an Inverted T.  Again, the length of the vertical portion varies.

Upright T – An upright T usually starts with a low transverse incision then a vertical incision down from the incision toward the vagina.  This can also result from the doctor starting a low transverse incision and then making a low vertical incision or when the lower uterine segment tears downward from the low transverse incision.  This is usually only done when the baby’s head is stuck in the birth canal. Like the others, the length of the vertical portion varies.

“with an extension” – What exactly is an “extension”?  An extension is where the doctor has stopped cutting with the knife and just separated the tissue with his/her hands or the tissue separated on it’s own while the doctor is pulling the baby out.  This may sound scary, but it happens and isn’t necessarily that big of a deal.  You will want to note how far your incision(s) extended though.  They can extend laterally (to the sides) or vertically.

What are the risks?

From Jessica from SpecialScars.org:

“There are no different risks for these types of incisions, just a SLIGHTLY higher risk of rupture.  I don’t think I’d ever want to induce on one of these scars.  For myself, if I were having a verified problem that the baby needed out and I wasn’t in labor or wasn’t far enough along in labor, I might opt for the RCS rather than trying any form of man-made chemical induction.  I might try nipple stimulation, sex, other less stressful forms of induction, it would depend on situation at that moment.

“I would also be less likely to try a manual version with one of these scars, I can say this honestly, my vbac baby was breech until 39-40 weeks.  I tried everything else, but a manual version was not a happy thought for me.”

VBAC Stories

Can I have a VBAC?

Other moms have! While not many doctors are researching this, here are some stories from moms who are planning VBAssCs.

Resources:

Special Scars ~ Special Women – Studies and birth stories abound!
Special Scars ~ Special Women Yahoo Group
Special Scars ~ Special Women Facebook Group

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