Uterus scarring from CS and sepsis?

[beakerandburette]

I am 22 weeks pg with DC2. Didn't exactly have a textbook birth with DD (1year ago) ended up with sepsis after prolonged rupture of membranes and failure to progress so had an EMCS under general anesthetic. I've recently had an appointment to discuss childbirth options with my consultant and been very firmly told that a vbac will be dangerous as my uterus has been damaged by sepsis and my CS scar. I've heard lot's of positive stories about elective caesareans but have been told by the doc if I have a cs this baby will be my last and I have a 1/50 chance of having to have a hysterectomy (due to the nature of my scarring and the positioning of my placenta). The thought scares the shit out of me, I'm 22 and imagined my self with a big family. Just wondering if any one has been through similar or can offer me any advice?

When you have a surgical birth the surgeon will document regarding different aspects of it to inform subsequent pregnancies. While three is the standard 'safe' number for LSCS some will have two and others five.

You could ask for a second opinion.

DO you have an anterior placenta or placenta praevoa?

Anterior placenta.

Well as you are only 22 weeks there is a good chance it will grow away from your scar as the lower segment forms.

It might be worth getting together with a well regarded supervisor of midwives from your hospital to discuss it. They will lay it out on the table for you and let you know whether an MRI to investigate the scarring and placental plantation seems to be of use in confining your consultants fears.

Confirming*

Don't be shy about getting the information, this birth determines your families future plans.

But you are a family already don't take unnecessary risks. For example IOL is a no no no, in fact if it's any labour it should be good normal progress or abandon it.

I am not sure if this article has anything about sepsis, but it talks about scars and the impact they can have in great detail:
wellroundedmama.blogspot.co.uk/2009/02/ultrasound-measurement-of-cesarean-scar.html?m=1

Arabella, unfortunately I don't think that article is particularly helpful for the OP.

I read the article because I have had one ELCS and am considering ttc again, so it seemed relevant to me.

However, the content of the article was very pro-VBAC and didn't really cover the demerits of VBAC. It was veru negative anour first CSs and painted quite a bleak picture of birth after CS.

It seemed like individual conjecture based on flimsy and inconclusive evidence.

OP, speak with your midwives and consultant again and maybe request a second opinion, as another poster advised. The NICE guidelines or 'green top' website might be better places to look for statistics - but you obviously would need to consider this in direct relation to your uterine issues, which is why open discussions with your caregivers are necessary.

I wish you all the best with the rest of your pg and a happy and peaceful birth x

Please excuse my type-o's! Hope that made sense.

beaker, I think your situation is quite complex and I don't think that any of our experiences with VBAC or further CSs will give you the answers you seek.

I agree with speaking with your obstetric team, and then speaking to them again. I also agree with seeking a second opinion - as no doctor has a crystal ball, nobody will be able to give you any kind of certainty what the best course of action is, but you'll find that different consultants have differing levels of risk-tolerance - as different women will have different levels of risk they can comfortably live with.

Sepsis refers to the infection having spread to your blood stream which is of course dangerous (and I am glad you are ok), but on the face of it should not affect the 'strength' of your scar.
Uterine rupture is a risk after every CS, so I'd ask some more questions about why they think your risk is higher than the next person who attempts a VBAC.
Also, many women have had more than 2 children by CS - again, ask the question, why would they say you could not have further children if this one was delivered by CS?

Anterior placenta at 22 weeks is neither here nor there - it might move up or not, you'll just have to wait and see.

1/50 chance of having a hysterectomy also means 49/50 chance of NOT having a hysterectomy.
It is really quite difficult to get your head around the concept of risk, I find.
What is the risk of having a hysterectomy at any delivery even without your previous history, I'd like to know?

Doctors try to (or should try) to share the decision making with you and the communication of risk and the uncertainties involved in any situation often errs on the side of Worst Case Scenario.

I dunno - I think you just need to keep communication going to fully understand what their concerns are in your specific case and also to understand what level of risk you are prepared to take.

Btw, I had VBAC x2 and all was well, but did of course not have some of your complications. My CS was for Placenta Praevia and DS2 was delivered at 31 weeks.

V best of luck with the rest of your pregnancy.

Thank you all for your replies. Unfortunately the doctors have told me I should have a ELCS and be done and dusted. I am finding the whole situation very stressful and feel that the disregard for my mental well being is crushing. I had such a bad experience last time and just don't know what to do. I had my heart set on a VBAC and am unsure if my hospital is maybe just a bit anti-vbac as most people who have had caesareans and 15ish month gaps between deliveries have been encouraged to have a vaginal delivery. Obviously each pregnancy/birth is different but I feel my CS wound healed quite well and my stomach feels very strong. Also I have only had routine ultrasounds to check on baby at 11 weeks and 21 weeks, there is no indication of uterine scarring etc in my notes so I am wondering if perhaps the hospital are trying to scare monger me into a CS? Would they do that?

Sorry if that does not make much sense. Feeling very up and down at the moment and just really want someone to hold my hand and tell me it will all be ok.

Get a 2nd opinion.

Speak to them until you understand why they advise as they are.

I am not aware of longterm scar issues (internal scars, I mean) due to previous sepsis

Have you looked as CS rates of your hospital?
CS rates are high everywhere but there are considerable variations between hospitals and between individual consultants.

You need to understand what advice you have been given and the reasons for it.
Nobody can make you have a CS. Or a VBAC for that matter.
But it is crucially important that YOU understand what the concerns are.

Fwiw (and I've said this with monotonous regularity on threads like yours) IMVHO the mode of delivery is such a teeny-tiny part of being a parent that it is useful if an expecting mother can keep a bit of an open mind about what happens.
I had a heavily medicated induction for post-dates resulting in VB, an emCS at 31 weeks for PP, and 2x VBAC. I am convinced that I feel as content as I do about all four of these deliveries because I always understood what was happening and why - I have happy memories of all of them (well, shit-scared for DS2 but not unhappy about how his delivery was managed).

Having said that, you need to get your head around this so that whatever happens in the end you don't live with 'what ifs' and 'had I onlys'.

It is really hard, don't be despondent, arm yourself with information, set up another appointment and keeping talking to folks. You may need to be quite assertive because everybody is busy and your questions may not fit in the standard number of appointments, but hey ho.
Phone your consultants secretary and ask her to set up a meeting with him/her.
Write your questions down.
Write their answers down.
Ponder things for a bit and then ask some more questions

Oh, and it will all be ok

Is this of interest? - you can follow the link if you want to see the actual numbers/hospitals.

Thank you Dogwood. You talk sense, I know the main thing about childbirth I a healthy baby at the end of it. I worry about how a CS will affect my bond with DC2, I know I felt like DD wasn't even my baby when she was just handed to me in the recovery room. I don't even remember our first day/night together because the GA made me so groggy. Also I failed at breastfeeding DD and will be broken hearted if I can't do it again. I'd love to see the rates for my hospital but I think that article only refers to English hospital trusts. I'm up in Scotland. Thank you for your reassurances.

Ta-daa! - Scottish hospitals

I'm in Scotland too - PM me if you want.

Also, an electiveCS (if that's what you end up going for) is a massively different experiences from a 'crash' section under GA.
Yes, the main thing about childbirth is a healthy baby and a healthy mother, but that also includes the mother's mental health and you should aim to have the delivery you can live with and hopefully have fond memories of. Your first one does not sound like it was like that….

Ah, rubbish, there's nothing on individual hospitals in what I linked to, sorry! It does show rates by health boards.

I have had an EMCS and, although c-scarring might be connected with our unexplained secondary infertility (suggested by the clinic where we had investigations), the experience of a CS can be really positive.

For example, you can ask for lights to be dimmed or the screen lowered at the moment of delivery, for you or DH to announce the gender, to have music you want playing...I latched my son on in recovery and we bf successfully for a very long time. Most people describe ELCS as quite 'chilled', so hopefully it would be that way for you...

I am due my 4th section in august, on my third section I did have an extra surgeon in surgery with me incase any scar tissue removal was nessesary, but it wasn't. My first section was an emergency but not under ga, an emcs and an elcs do not compare, the latter being far more calmer! For info dc2 had an anterior placenta, dc3 had a low lying placenta, and all dc have ranged in weight from 9lb to 10.9lb and that one was dc2 with the anterior placenta! Could your hospital be worried about sepsis if you tried for a vbac? It's worth asking. Sepsis is a killer and very often overlooked and picked up to late to save people, and families like mine are left to deal with the aftermath for a lifetime.

cathpip the sepsis was caused by prolonged rupture of membranes so I think I would be very unlucky to get so ill again.
I think I am starting to make peace with an ELCS, I just want my baby to be safe and I would feel so bad if I went against consultant recommendations and ended up with a poorly baby.
Maybe sorry to hear you are having fertility problems I have my fx for a bfp for you soon.
I've also found out this week that the previous surgery has left me with adhesions on uterus which is bloody painful. The joys of babies and childbirth huh?!

I would echo the message that an elcs would be very different to your crash cesarean which undoubtedly would have been traumatic. Making peace with the idea, as you say, and perhaps also appreciating that this can be offered as an option to keep you and baby safe, free on the NHS. Amazing really. I'm not pro cs or otherwise but am pro NHS and really think it's amazing that we live in a society wherewe can access this kkind of treatment. I know that line of thinking doesn't necessarily make your own personal decision any better, but something to hold in mind. Best of luck.