Posted by My OB said WHAT?!?.
May
18
Posted by My OB said WHAT?!?.
“Sew Her Up Nice And Tight For Her VBAC.”
“Sew her up nice and tight for her VBAC.” – OB during surgery for an unplanned cesarean.
There are 15 comments to this post.
I wonder if the OB said this in a mean, callous way or perhaps it was a resident doing the work, or perhaps the c-section was for the ob’s convenience or maybe even he/she was being sarcastic about the chances of VBAC? Yep, like all of you, wondering about this one…
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Hmmmm….yes a pink link would be helpful. I took a VBAC info class and was told that one of the reasons that so many docs now-a-days are against VBAC is that the quality of repair for a first section may not allow for a strong enough uterus for VBAC. There is a right way and a wrong way to sew up a uterus, so I am interested to know if he was advocating sewing her up correctly, or being sarcastic and mean-spirited.
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Lizzie K Reply:
May 18th, 2012 at 8:37 pm (Quote)
When I first read it, I thought it sounded good, then realized it’s not Thursday, so I kind of pictured the doctor saying it in a very sarcastic, condescending tone of voice. I really want to see the pink for this one.
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Cara Reply:
May 18th, 2012 at 11:07 pm (Quote)
I dunno, it sounds creepy to me. Like they don’t normally “stitch [them] up nice an tight”. It’s gross, really.
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Jane Reply:
May 19th, 2012 at 3:39 am (Quote)
My understanding is that it used to be universal to use double-layer suturing on the uterus, but then someone realized if you used single-layer suturing it saved about seven minutes in the operating room and was almost as good as double-layer suturing, and many doctors started doing that without there being any research saying it really was just as good.
(I’m not sure whether there is or is not, btw. I haven’t delved into this myself. But in the absence of research, I can see where some doctors would say “Single-layer suturing is just fine!” whereas others might say “Criminy, I can’t let you labor after single-layer suturing! Your uterus will explode!”)
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Details Reply:
May 19th, 2012 at 11:35 am (Quote)
Well since the risk of rupture during pregnancy is just as high as the risk of rupture during labor (of course the pregnancy risk is spread out over the last 4-5 month, whereas labor rarely last more than a day or two) I would hope they would all go back to doing it the right way. Another reason I’m glad I’m done and have been done since they introduced Cytotech.
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Knitted in the Womb Reply:
May 19th, 2012 at 12:51 pm (Quote)
Sigh. I guess a bad excuse is better than none?
Single layer suturing *has* been shown to double the risk of rupture in a small study–one that may not really be large enough to have statistically significant data: http://www.ncbi.nlm.nih.gov/pubmed/20567166
But that would bring it from something less than 0.5% (the overall rupture rate for VBAC) to less than 1%…right? But using Pitocin during a VBAC increases the risk of rupture to 1.7%. How many of the OB’s who are “uncomfortable” with VBAC for a single layer closure have no problem with inducing labor for a woman with a double layer closure?
This study http://www.ncbi.nlm.nih.gov/pubmed/17118738 further muddies the waters by showing a greater than 1% rupture rate for double layer closure, and greater than 8% rupture rate for single layer. But there were only 35 women in the single layer group, so how statisically significant can these results be considered? How in the heck do they even get published?!?!?!
But wait! There’s more! This truly horrifying study http://www.ncbi.nlm.nih.gov/pubmed/20082597 found that double layer suturing was more than THREE TIMES as likely to result in rupture as single layer, with rupture rates at 5.28% and 13.11% Yikes!
So which is worse…the 8% risk of rupture for single layer closure in the second study…or the 13% risk of rupture for double layer suture in the 3rd study? I’d say overall that all of these 3 studies have huge flaws in them, that limit their usefulness in decision making.
Really, I think the abstract found here http://www.ncbi.nlm.nih.gov/pubmed/15310123 likely sums things up pretty well: “Some clinicians have used a single, poorly-designed, retrospective study of single-layer vs. double-layer repair of the uterus during cesarean surgery to justify denying women the option of a trial of labor on subsequent pregnancies.” Its multiple studies now…but “poorly designed” describes them pretty well.
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Ican’s position paper on this also adds that mothers tend to heal better with single-layer suturing, so I don’t believe expedience was the only reason for the switch to single-layer. http://www.ican-online.org/vbac/the-suture-debate
Also, there is some newer evidence coming to light regarding suturing material and stitch pattern (and here I thought stitch patterns were just for us knitters…): http://www.midwiferytoday.com/articles/homebirthaftercesarean.asp
But I agree, since this didn’t appear on a Thursday, I’m going to assume this was mocking someone’s birth plan (maybe it stated that in the case of a cesarean birth, please use double-layer suturing or something of the sort), or mocking her desire for a natural birth in the first place. 
If so, I’m so sorry OP that you were treated so heartlessly at what must have been a difficult time.
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This should be a Thoughtful Thursday!
I was begging them to make sure they did everything they could to sew me up so I could VBAC.
I’m sorry you have to have an unplanned c-section, but having and OB that would even mention, let alone sound supportive of a VBAC is awesome!
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Claire Reply:
May 18th, 2012 at 2:58 pm Claire(Quote)
I think there is more to the story. Maybe it was sarcasm, I don’t know. I’m holding judgement for the pink link.
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Penny Reply:
May 18th, 2012 at 2:59 pm Penny(Quote)
Definetly need more information on this one.
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Ethel Reply:
May 18th, 2012 at 3:07 pm Ethel(Quote)
I absolutely agree, if we were talking about an episiotomy or a tear it’d be one thing but a c-section is something else.
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