Scar thickness if considering VBAC

Dr Vijaya explains about Scar thickness in VBAC and how a woman with a lesser scar thickness also can have a normal delivery

Many times when the doctors think about advising the woman, whether she should be having a VBAC or not. One of the things that is told to her that we have to measure your scar thickness. Results worldwide have talked about that there must be at least a three mm thickness of the scar and if it is below that, then there is a less chance of, you know, you’ll having a successful VBAC and increased chance of rupture happening you this way from having it.

But again, research shows us that it is not that cut and try. A woman with a lesser scar thickness might land up having a perfectly healthy normal delivery after the previous C-section, and one who has excellent thickness may have a chance of rupture. And that’s why current evidence tells us that scar thickness alone should never be used as a standalone method or a stand-alone tool to discourage the woman from having a VBAC.

A lot of times we do know, for example, that women who are otherwise healthy have a better chance of having a normal Vbac, a successful VBAC. A woman, for example, who has a very high BMI, a woman for example, who might have gestational diabetes and a bigger baby, a woman for example, who might have high blood pressure, co-morbidities, for lack of a better word, or a woman who is otherwise not active. A woman who is fearful, mental, physical, emotional – we talk about this all the time. A woman who does not have good family support systems, these might be the woman who might have prolonged labors for whatever reason and that might again, increase the risk of her scar rupture. We do want normal, healthy, healthy lengths of labor, for lack of a better word.

In practice, what we see is that VBAC mothers tend to have a long pre-labor period. This is something that we don’t see in the literature mentioned, but with like for in our center, most of the months we have one-third of the women who are under our care having a VBAC. And for me, that tells me two things – one is that women are being cut up far too often. And two is that – the success rate that we have, which closely mirror somewhere between 88 to 92% in any given year, tells me very strongly that women are capable to have the babies by natural birth after a previous C-section. If that woman has is induced, for example, that increases her risk a lot because now you have these contractions which are much stronger. They are longer, they’re closer together from the word get-go when she should have been in early labor. Right. So pre-labor is a little bit longer for these women and to me, it feels as if the woman’s body is instinctively doing the work in a way that is going to keep her safe.

Because if she has these small contractions over many days when it comes and goes and is there for maybe only two to three hours, her body’s already going to get her baby further into the pelvis. Maybe her cervix has already softened up. We miss all that when we say – due date, come get admitted, induce because of XYZ factors, or you all tell her that no because you have not gone into labor by your due date now suddenly your risk has increased.