Vbac with a mullerian anomaly

Following on from this post I just thought I'd post a bit of the research I have been finding and reading. I hope it helps someone. Please note if you have a normal uterus you may want to stop reading now as this probably will be rather dull, unless you are particularly interested in dodgy double uteri.

Realistically speaking there aren't any answers I suppose, statistics are never answers. I have found two studies, one of which Sacred and scarred has posted here and the other of which is here and there is a tiny bit more detail here Unfortunately that seems to be all the research I can find, and it has no specifics for the different types of anomaly, but the study groups are very small anyway.

I'll copy and paste the relevant bits though to stop you having to sift through it all.

Firstly I guess the bit you may be interested in are the outcomes

Of 5571 eligible patients, 165 (2.96%) had Müllerian anomalies. The rate of vaginal birth after cesarean section was significantly lower among patients with Müllerian anomalies than in patients with normal uterus, 37.6% (62/165) vs 50.7% (2740/5406)

So much lower vbac rates among people with mullerian anomalies, however

The major indication for repeated cesarean delivery among Müllerian anomalies patients was malpresentation

So it was mainly due to the fact that babies are more likely to be breech. Of people that attempted a vbac so presumably weren't presenting as breech

The cesarean delivery rates were 20% (5/25) and 25.1% (448/1788)(this is the normal uterus group), respectively

So if you are presenting normally and get chance to vbac there is a good chance you may acheive one. However as I'm sure you know you are much more likely to be malpresenting with a dodgy womb then you are with a normal womb.

However in vbac one of the main things to conside is the risk of uterine rupture.

There were 1813 attempts at vaginal birth after cesarean delivery between 1992 and 1997 at the Foothills Hospital in Calgary, Alberta, Canada. Of the patients 25 had known müllerian duct anomalies and 1788 did not

The rates of uterine rupture were 8% (2/25) in the group with müllerian duct anomalies and 0.61% (11/1788) in the group without müllerian duct anomalies

8% sounds very high, however note the bit in bold

The authors studied five years records in Calgary and found 25 such women who had tried for vaginal deliveries after a previous caesarean. Two of them suffered a ruptured uterus (8%) but both had been induced with prostaglandin gel, and one had had oxytocin as well. Although the rate of rupture was only 0.61% in the 1800 women with apparently normal uteri, the authors do not say how many had had prostaglandin or oxytocin and whether that added to their risk.

In contrast the other article comes to the conclusion that

A trial of vaginal birth after cesarean section in patients with uterine Müllerian malformations and cephalic presentation is not associated with a higher rate of maternal morbidity and uterine rupture

It's hard to tell really whether vbac with a dodgy uterus is more likely to end in a rupture, but it seems fair to say that being induced vastly increases the rate of rupture. Induction does increase the rate of rupture with normal uteri too, but to nowhere near the same extent.

This is the bit which I personally find most relevant though

All cesarean deliveries among women with müllerian duct anomalies were performed urgently in response to severe fetal heart rate abnormalities. The rates of fetal heart rate abnormalities necessitating immediate delivery (60% vs 14.1%, P =.013), operative vaginal delivery (40% vs 19.6%, P =.02), and cord prolapse (8% vs 0.45%, P =.0076) were significantly greater in the group with müllerian duct anomalies.

My DS was born by section due to his heart rate falling a lot. This is something I hadn't considered, I just presumed it was one of those things and hadn't considered it could be due to my uterus shape. I feel this is something I'll have to research a bit more.

I guess the conclusion that I have reached is that as long as you aren't carrying breech you are just as likely to get a normal birth after a caesarian as anyone else, but when things do go wrong they are much likely to go badly wrong. I think the thing is to do what feels right to you, and not what you think others think you should do. Statisitics and other peoples stories never tell your story.

3 things that have made me smile.

I went to see my friend Hazel last night and we were talking about being positive and sometimes just stopping to think of 3 things that have made you smile today. They don't have to be big things, just things that make you happy.

Anyway it may only be 9.30am but here are three things that have made me smile this morning.

My new nappies and wipes that arrived in the post at 8 this morning. I love My funkly nappies.

My Damson tree which now has lots of lovely ripe damsons that my brother is going to pick for me today. Then it is jam making time, and there is no nicer jam then homemade damson jam.

And thirdly the fact that I'm not in pain this morning. Yesterday I was achey and in so much pain, to the point I nearly cried when they said the midwife drop in had changed from afternoons to mornings so I'd have to wait a week to see her. This morning it has eased so much and I can actually walk faster then a snail which was all I could manage at my worse yesterday dinnertime. The power of prayer and a good nights sleep!

So what 3 things have made you smile today?

21 weeks today!

Excuse the mucky mirror, this was taken in my parents junk room, but here is my first bump picture, today at 21 weeks

2 posts in my head

I currently have two different posts in my head. One about supporting those things that matter to you, the other about the strangest things bringing back memories. Then to add to that I have a lot floating around in my head about happiness when those around you are suffering.

I'll try and get this all out of my head and down in words but you'll have to excuse me if doesn't all join together and make sense. I'll try not to be too long about it!

The strange things bringing back memories thing was brought about, oddly enough, by a pair of stripey socks. More to the point, stripey socks with a hole in. I was thinking I should throw them away. Then this memory image popped up in my head as clear as anything, of me in hospital, bare from the waist down except for these knee high stripey socks, being examined as I miscarried. It isn't that I don't think about the miscarriage, I do often, but it is no longer at the front of my mind. Then suddenly there it was, as clear as day, this image from the day I lost Arthur. Down to the doctor apologising as blood dripped on said socks. I don't really know what else there is to say about it, but I needed to say it somehow.

As for supporting the things important to you this was brought about this morning. Sometimes it is easy to forget how much financial support it takes to keep most charities going. I was sat reading about a young girl being raped, while similtaneously on msn my Hubby was telling me he had been given a bonus at work and was sending some money to my account. As I sat crying about this young girl, a charity I know of popped into my head, and I realised how important it is to support these charities so they can support people like this girl. I once went to 3 seminars run by the woman who runs the charity and the work they do is fantastic. I just want to encourage you to support the causes that are important to you. It can be so easy to forget with the day to day of paying bills etc, but every small bit helps.

Lastly I just feel we are so blessed at the moment, but so many people around me and close friends are really struggling. I know we all have points of up and points of down, and there have been points when it has been me going through the crap, but at the moment there seems to be a lot of suffering. 2 close friends have recently lost parents, one this week, just a month after my friend got married. Several friends are really struggling with depression, one to the point of several attempted suicides. People trying unsuccessfully to have babies, people in difficult relationships, a friend of my husbands recently diagnosed with cancer, and people with just a lot of general sadness in their lives. These are the friends I know are struggling, not to mention the ones trying to keep everything together without telling a soul. I don't want to be wrapped in my own little bubble, but sometimes I don't know how to start.

Well I was wrong.

We are having a little boy! I'm over the moon, but I would be either way. And he sleeps with his hands behind his head just like his brother sometimes does.

Butterflies

Tomorrow is my next scan, The butterflies in my tummy aren't all just the baby moving this evening. Hopefully all will be well and by this time tomorrow we will know whether we are having a little boy or girl. I'm leaning slightly towards girl but really not sure, time will tell!

A couple of holiday snaps

We have just come back from a lovely holiday in Brittany in France. The weather wasn't the hottest, but it was dry and not too cold and we had a lovely time. We went with the inlaws and some aunts and uncles and it was great to have the family time, lots of lovely food and a mainly relaxing 10 days.