Interesting article - SMFM Consult--Prior non-lower segment uterine scar

This blog entry is a bit dated (2013), but it provides a nice summary of a few recent studies.  Make sure you scroll down until you get to the discussion on myomectomy (Question #2).

http://contemporaryobgyn.modernmedicine.com/contemporary-obgyn/content/tags/cesarean-delivery/smfm-consult-prior-non-lower-segment-uterine-scar?page=full

More VBALM

One of the challenges in researching birth options is finding medical articles that provide unbiased research and results.  I have done a lot of digging around, and will continue to post the articles that I have found.  

Remember, just because these articles need to be paid for does NOT mean that you have to pay for them out of pocket or that you can't read them.  Simply go to your public library and request that they place an interlibrary loan request for you!  If you are really stuck, email me and I will help you get access to them.  

"Pregnancy and delivery after laparoscopic myomectomy" by Jun Kumakiri, et. al., Journal of Minimaly Invasive Gynecology, Vol. 12, Issue 3, pg 241-246 (June 2005) (Pubmed, ScienceDirect, WorldCat). 

"Prospective evaluation for the feasibility of vaginal birth after laparoscopic myomectomy" by Jun. Kumakiri, et. al., Journal of minimally invasive gynecology, Vol. 15, Issue 4, pg 420-4 (Jul-Aug 2008) (PubMed, ScienceDirect, 

"Perspectives of obstetricians on labour and delivery after abdominal or laparoscopic myomectomy" by Hélène S HS Weibel, et. al., Journal of obstetrics and gynaecology Canada, Vol. 36, Issue 2 (PubMed)

"Pregnancy Outcomes and Risk Factors for Uterine Rupture after Laparoscopic Myomectomy: A Single-center Experience and Literature Review", by Yu-Jin Koo, et. al., Journal of Minimally Invasive Gynecology (Available online May 2015) (PubMed, ScienceDirect). 

Laproscopic Myomectomy

When I decided to try for a VBAC, I had to do a lot of research to prepare myself.  I wanted to make sure I understood what the risks were (both for VBAC and C-section).  This was made more difficult by my lack of surgical report, but I was able to piece together my history using my surgery video from 1997, plus talking to a doctor who was actually willing to review my video with me. This is what I learned about my history: Laproscopic Myomectomy - 1997

Intramural fibroid

4-5 cm

Left side of uterus - cornua - near tubal opening

Removal went into the wall, but did not enter the uterine cavity

Suturing done laproscopically 

C-section - 2010

• Low transverse 
• After first c-section, doctor said no visible scar at the cite of Laproscopic Myomectomy

C-section 2013

• Low transverse 

I then had to research medical statistics and findings.  My favorite databases were pubmed, ebscohost, proquest, and google scholar.  I was able to run searches in these databases using keywords like:

• Laparoscopic myomectomy 
• Uterine rupture
• Vaginal delivery 
• Vaginal birth
• VBAC
• VBA2C
• Cesarean
• C-section
• Uterine scar
• Delivery outcome

I found a lot of great articles, even some newer articles that have been wonderful for my understanding of the risks and making informed decisions.  Here are a few articles I've found:

• "Evaluation of factors contributing to uterine scar formation after laparoscopic myomectomy" by Jun Kumakiri, et. al., ACTA Obstetricia et Gynecologica Scandinavica, Vol 89, Issue 8, p 1078-1083 (Aug. 2010) (PubMed, Wiley)

• "Prospective comparison of delivery outcomes  of vaginal births after cesarean section versus  laparoscopic myomectomy" by Makino S, Tanaka, et. al., Journal of Obstetrics and Gynaecology Research, Vol 34, Issue 6, p 952-956 (Dec 2008) (PubMed, Wiley)

To read these articles, check at your local library to see if they subscribe to the articles the articles are published in.  If they do not, request through your local library's interlibrary loan!  A reference librarian will be able to help you!

VBA2C

I'm not shy about the fact that I hate that I've had c-sections.  I went into my first c-section in 2010 assuming that I didn't have a choice.  I had a laproscopic myomectomy in November 1997.  Because I hadn't requested my record or had children in the 10 years after my procedure, they were routinely discarded by the doctors office.  I did however have a VHS video of my procedure (which I converted to DVD and Youtube), but my OB/GYN wasn't interested in looking at it and we discussed nothing except for a scheduled c-section.  The second c-section was in 2013 because when I brought up the idea of a VBAC they scared me with uterine rupture horror stories and statistics that were more severe than my research indicates.

So, I went in to my c-section in June 2010 unprepared for what it would mean for taking care of my newborn, recovery, possible complications, and its impact on my future pregnancies and births.

I delivered b1 at NYU Medical Center in NYC, and overall I was happy with the level of care I received there.  My veins collapsed when a resident was putting in my IV and I passed out, so they immediately sent in their supervising doctor who quickly and easily put in my IV while also putting me at ease.  The beginning of my procedure was routine.  My epidural was started with no issues, the surgery started with the doctors, nurses, and other support staff listening to the world cup in the background (note: this is a good reason to come prepared to your birth with music or directions for what will be playing in the background while your baby is being born).  I thought the procedure went fine, but didn't understand why it was taking so long for them to bring b1 to me after she was born.  Unfortunately, during the c-section her face was cut with a scalpel, so they had to tend to that before she was brought to me.  

Luckily the laceration didn't hit anything vital on her face, this happened at NYU.  The head of plastic surgery quickly came to our recovery room, discussed our options with us, and b1 received plastic surgery on the cut within 90 minutes of being born.

Even though b1 had no difficulty nursing, it was very painful to hold her while nursing, and to find a comfortable and effective nursing position.  Then, not too long after going home my c-section incision opened up again and got infected, which required trips to NYC from NJ to get tended to. Overall, NOT FUN.  

As an active person who wants to interact with my children, the recovery process is brutal.  I don't want to be afraid of my children hurting me after giving birth.  I want to be able to play with them, and read to them, without being in horrible pain.  I don't want to be on pain medications for weeks following the birth.  I want to be able to go for walks outside if and when I want to.  I just want to be able to enjoy the days after my child's birth.  To bond, and revel in their existence without having to recover from major abdominal surgery.  

Finally, I still find it surprising by how many people that didn't recognize that a c-section is major abdominal surgery and realize how long and hard it is to be "back to normal".  

All that just to say I really hate c-sections and the recovery.  I really don't want to have another one. 

A lot of people won't understand this, and will think I'm crazy for trying to have a VBAC, but I know this is what I want.  If I need to have another c-section, so be it.  But I want to at least TRY! 

Braxton Hicks (baby bump 23 weeks)

Well, I am now 23 weeks pregnant with b3, and it seems that the braxton hicks may have started already.  It is funny how much of pregnancy you just forget.

Some of my favorite things about being pregnant:

• AMAZING feeling/seeing life grow inside of me
• How b1 & b2 react to the idea of their baby brothers impending arrival
• the kicks of the baby
• anticipation of meeting this little guy
• strong healthy hair (it just doesn't fall out!!!)

Some of the things I hate about being pregnant:

• Fear of another c-section
• Heart palpitations making me feel weak
• being uncomfortable
• Insomnia (this just started up again about 2-3 weeks ago)
• Heart burn
• Not being able to play as hard with my kids
• Swollen feet, ankles
• feet growing an ENTIRE SIZE!!!
• side sleeping & the back/neck/shoulder pain that comes iwth it.

So, with this pregnancy, I'm working with a midwife to attempt a VBAC.  I'm actually trying for a VBALM2C (Vaginal Birth after Laproscopic Myomectomy & 2 C-sections).  Luckily, I am working with a fearless pioneer in the midwife industry that has incredible experience.  I'm in the process of trying to hire a doula to help, but I'm having trouble deciding on who to go with.  

Photo taken by b1 - 23 weeks (up 16 pounds)

23 week selfie