Anterior lips and future deliveries

[Chixie]

Im a student nurse who got to spend a day on delivery. One of the ladies had an anterior lip and was given a c section-My question is would this lady be able to have future children naturally or would she be required to have an elective c section?

[icyounurse, BSN, RN]

I am sure someone who is an L and D nurse or just plain more knowledgeable than me will come and add more here, but I believe it depends on the incision?

If the incision is horizontal and low across, and there is only one c-sections scar, you can have a V-bac (is that how you say it?)which means lady partsl delivery after c-section. I think its only the classical vertical incisions, or more than one previous c-section that require further c-sections. I would think that also it would depend on why you got the c-section.

But L&D/post partum nurses please correct me if I am wrong, not my area of expertise:nurse:

[LizzyL&DRN]

Based on your description the indication for the c section was probably failure to progress and/or cephalopelvic disproportion. What it means when they say "anterior lip" is that cervix can only be felt on the anterior portion and cannot be felt on the posterior area. We frequently describe this to the pt's as being 9 1/2 cm dilated to put it in perspective for them. If they will not dilate further than this and baby is not engaged in the pelvis it can be an indication that the baby will not fit. As far as having a VBAC for later pregnancies goes.....second babies are frequently bigger than first babies so unless they think the baby is smaller the second time around she probably would not be a candidate. It is also true what the previous poster said about the direction of the incision. A "classical" incision is made in the vertical position and is not generally done here in the US. A "transverse" incision is done horizontally just above bikini line. A patient with a previous "classical" incision in the uterus is not a candidate due to risk of uterine rupture.

[CEG]

there is only one c-sections scar, you can have a V-bac (is that how you say it?)which means lady partsl delivery after c-section. more than one previous c-section that require further c-sections.

Actually my hospital (a large teaching hospital) does VBACs after more than one c-section. There is no evidence that it is any more dangerous as long as the mom remains low-risk in other ways:)

[APBT mom, LPN, RN]

Just wanted to add about the VBAC's it usually depends on the MD. In my area there are a lot of OB/GYN's that will not allow a patient to have a VBAC because of the possibility of uterine rupture. Most MD's usually require the pregnancies to be a least 5 years apart and that the c/s wasn't the result of any complications. Like the pp said the second pregnancy usually results in a larger infant so that's something that had to be factored in too.

[judy ann]

A small comment on the incision and where it is. Remember--the incision that is important is that of the uterus. Some docs make a vertical skin incision, and a low cervial uterine incision (don't ask me why--I see no rhyme or reason) So, if y9ou see a vertical abdominal scar, the medical record should be checked to make sure of the uterine scar. This can go the other way also--bikini skin scar and classical (vertical ) abdominal scar.

[Elvish, BSN, DNP, RN, NP]

Depends, like other posters have said.

It depends if the same situation that led to the first c/section is also present with a subsequent pregnancy. Depends on the uterine incision, whether horizontal (transverse) or vertical (classical). If the incision is horizontal and the risk-factors no longer exist, there's no real reason to deny the lady a VBAC. Some docs, however, are no longer doing VBACs for whatever reason.

[NurseNora, BSN, RN]

VBACs should be done in hospitals which can do an immediate C-Section in the event of a uterine rupture. Many smaller hospitals do not have 24/7 in house anesthesia, first assist and OR team, so they don't do VBACs. But larger, often urban, hospitals do have all this in place and a C/S can be done in moments, so they do VBACs.

A significant percentage of women (I forget the exact percentage although I used to know it; I think over 50%) are able to deliver a baby by VBAC that is larger than the baby they were sectioned for. It's about position as much as size. There is so much that can be done by encouraging the patient to move rather than lie in bed for labor. Even patients with epidurals can be positioned in ways that promote the baby to move into the best position for delivery

[Elvish, BSN, DNP, RN, NP]

I get spoiled working in a big hospital where we always have in-house anesthesia/OR. I forget that everybody doesn't have that all the time.

[lisamct]

An anterior lip isn't an indication for section so there must have been other factors going on that you maybe didnt pick up on. Babies position may have been a factor although there are often maternal positions you can use to try and 'fix' this (if your woman isnt flat on her back with a total block epidural that is) or maybe there was an issue with fetal distress. Do you now if anyone tried to manually help with the anterior lip by trying to push it back during a contraction? Crappy thing to do to women but if its the only way to get her a lady partsl delivery its often better than a potentially un-necessary section.

As for her chances at a VBAC I'd say that here in the UK they're pretty good. VBAC's, or at least trials of labour, are becoming more and more common especially when the cause for the original section is something that may have been specific to that original labour.

[LaborLovinRN]

The pt being able to VBAC will depend on facility policy as well as the MD. The hospital policy on VBAC's is usually dictated by the insurance carrier. For our facility, in order for a physician to authorize a VBAC, that MD or the covering MD must be in house while the pt is laboring in case of uterine rupture. (We have 24/7 anesthesia, so that isn't an issue for us) For our Kaiser docs that isn't a problem, they are 24/7, but for the community docs, they aren't going to remain in house, so they don't offer the VBAC option to their pt's. The Kaiser docs will VBAC as long as the pt has not had more than 2 c/s, and as long as the previous c/s was more than 24 months ago.

That is just what we do in our little corner of the world!