A Case of Vaginal Birth after Cesarean Delivery in a Patient with Uterine Didelphys

Uterine Differences

Successful Vaginal Delivery after External Cephalic Version in a Woman with a Large Partial Uterine Septum

Needed Website

How to VBAC: The Ultimate Prep Course for Parents

Full Transcript under Episode Details 

Meagan: Hello, everybody. Welcome to The VBAC Link. This is Meagan, and I am solo today. We will not be sharing a VBAC or CBAC story, but we’re going to focus on our topic of the week. That is uterine abnormalities. 

So if you haven’t listened to Flannery’s episode last week, or I should say earlier this week, go check it out. Flannery has a bicornuate uterus, and we talked a little bit about the different types of uteruses, and her journey, and what happened or what was most common with her bicornuate uterus. 

But today, I wanted to talk a little bit more about the different types of uteruses. 

It’s kind of weird to think about, but we do. We have multiple shapes of our uteruses. I don’t think it’s really talked about a lot, so I thought it would be cool to jump on today and talk a little bit more about the uteruses. 

But, we do have a Review of the Week, so I wanted to jump on and share this review. It says, “I now recommend this podcast to every mom who will listen, even first-time moms. I tell them this is the podcast I wish I would have listened to before our first traumatic birth. It helped me process, learn, and heal so much after my son’s birth. Two years later, pouring into numerous books, online courses, and more, we are preparing for our October VBAC. Their podcast has by far been the most favorite resource hands down. Thanks, Julie and Meagan, so much for what you do.”

Thank you guys for your review. That review was left on Google, so if you wouldn’t mind, press pause in just one moment, and go leave us a review. Your reviews help other Women of Strength come and find this podcast, find the blogs, find the course, find the doulas. You guys, I love this community so stinking much and believe that every mom, just like the reviewer said, and even first-time moms should be listening to this podcast. These stories that you guys share are absolutely incredible. The information that we share is invaluable. 

If you can, go to Google. Type in, “The VBAC Link” and leave us a review, or leave us a review wherever you are listening to your podcasts. 

Okay, everybody. Like I said, we are going to be diving into uterine abnormalities. We talked a little bit about Flannery. She had a bicornuate uterus. 

What is a bicornuate uterus? A bicornuate uterus is a heart-shaped uterus meaning the uterus has two horns making it look like the shape of a heart. With bicornuate uteruses, there are some things to know. There can be a higher chance of a breech baby. I’m going to share my source here with you. It’s pregnancybirthbaby.org. We’re going to have this in the show notes. I think that it is just so great. It’s such a great visual and understanding on the different types. 

So yeah. They’ve got two horns. It doesn’t reduce your chances of having a baby or getting pregnant. It can increase things like early miscarriage or an early preterm baby, or like I said, it can impact the position of the baby. 

But it’s possible. VBAC is possible with that. The hardest thing about uterine abnormalities is there is not a ton of evidence or deep studies to dive into how it’s impacting people who want to go on and have a vaginal birth or go for a, in the medical world, TOLAC or trial of labor after a Cesarean. 

If you have a uterine abnormality, it’s something to discuss with your provider. Know you don’t have to go with that first answer. You can get multiple opinions. 

Okay, another uterine abnormality or shape is– oh my gosh, you guys. Don’t quote me on this. I will butcher how to say these. I will try my best. 

It’s a didelphys uterus. It means that your uterus is split in two, and each side of your uterus has its own area. it also can increase your chance of having a premature birth, so if that is something that you have, I think that’s something you want to discuss with your provider knowing that you could have a premature birth. 

We also know people who have premature VBACs all the time, but it’s something to discuss. 

There’s acruate, and that is a uterus that actually looks really similar to a normal-sized uterus but has a deeper dip in the top of the uterus in the womb. It doesn’t affect your fertility. It can increase just a little bit of a later miscarriage. That is something to discuss, although sometimes providers will want to induce if everything is looking well at an earlier gestational age. Also, this one can impact the position of your baby, so being aware of that. 

Then there’s septate. Again, I don’t know. Sorry for butchering this, you guys. If you’re a medical professional, sorry. It says, “A septate womb has the wall of a muscle that comes down the center of the uterus, and then it splits into those two areas and is divided by a membrane or a tight band of tissue.” It reminds me of a rubber band. It splits it down. 

It can also impact fertility and, again, increase the possible risk of miscarriage in the early stages or cause a premature baby. Once again, discuss with your provider if you have this what that means and what that means for VBAC birth in general. 

Then, let’s see. There’s also retroverted. That’s a uterus that tips further back instead of that forward stage. Again, there are so many different types and shapes of uteruses. Sometimes we don’t know what we have until we have a baby who is born. Sometimes it’s once we have a Cesarean where they are like, “Oh, hey. You have this type of shaped uterus.” If you really feel like you need to know or you are having issues or anything like that, dive in with your provider and see if they can tell you what shape of uterus you have.

Like I said, little is known about the outcome of VBAC with uterine abnormalities, but there is an article and it was back in 2019. It’s called “A Case of Vaginal Birth After Cesarean Patient Who Has a Uterine Didelphys”. I want to talk a little bit more about that. As a reminder, that is the one that is split in two. 

If I recall, I think they even have their own cervixes. That can be interesting. But this is going to be a little bit more on this. They talk about it. There are only a few studies. The studies are low, like 165 women in the one study. It shows that those women with abnormalities found were statistically less likely to have VBAC. 

Again, we know that a lot of the time, these people have babies who are in less ideal positions or they are going into early preterm labor. There are things to be said about that. But the other small study is literally teeny tiny. It had 25 women with uterine abnormalities reported, and a VBAC rate was similar to women with a “normal” uterus. 

There are things to say there.

Now, the other study showed that they were less likely to experience uterine rupture than women with normal uteruses, but then this one said that the uterine rupture rate was higher. So such little information. I mean, really, it’s little information that I have been able to find so far. I’m going to dive in deeper and update you, but yeah. It says, “The actual rates in VBAC and uterine rupture in women with uterine abnormalities are more likely to be similar or less favorable than those women with normal uteruses.” 

So, keep that in mind. It goes on and says, “Some authors hypothesized that uterine abnormalities, especially unicornuate uteruses, are associated with decreased uterine muscle mass. So when we have decreased uterine muscle mass, that means it may not contract as effectively or strongly as it needs to, so that can lead to other things like arrest of descent or we were not getting into that active phase of labor, needing things like Pitocin and things to augment labor or they may have a harder time pushing out the baby because the uterus isn’t helping as well. 

So we may have a higher chance of an assisted delivery like a vacuum or forceps. With all of this said, you guys, I want to leave it here with you to encourage you to speak with your provider, and get multiple opinions. 

If you have been told that you can’t VBAC because of a certain situation, dive a little deeper with questions with your provider because again, the hardcore evidence is not really there. It’s just low. I mean, it’s there, but it’s low. There’s another article that says that uterine abnormalities are common in the general population with an estimated range of 1-15 per 1000% women. 

We know that there are people out there who have uterine abnormalities. I don’t feel like it’s talked about a ton, and that’s why I wanted to come on today and talk a little about the different types, and of course, share with Flannery’s episode with a bicornuate uterus showing that she still did go on to have a VBAC and it is possible. 

So if you have a uterine abnormality, please know that it doesn’t mean you’re just completely off the table. It still can be an option. Discuss it with your provider. Check out the links. I will include them in the show notes today more on those uterine abnormalities, and what it means, and what these studies are showing. 

There was another one that said that a septate uterus is clinically significant because it has been shown to be associated with adverse pregnancy outcomes including, like I said, that preterm labor and malpresentation. So it’s a thing that can cause malpresentation and can cause preterm labor, and even miscarriage. 

But does that mean that you can’t have a vaginal birth? Another thing to ask your providers if you have any of these things are, “Okay, if my baby is in a less than ideal position, say, breech or transverse, does my uterine abnormality or my specific case rule me out of having something like an ECV?” Varying rates of ECV success have been reported, and we’re also not doing them enough. We are not seeing them being done enough, even though they have a lot of success. 

But the question is if you have a uterus that is a little different, do you qualify? Ask the questions. Be informed, and if you have any questions, let us know.

And hey, if you have a uterine abnormality and you are listening, and you had a VBAC, I would love to hear from you because we have people who are searching for stories with uterine abnormalities. I know that our community would love to hear your story. 

You can message us at [email protected] or if you are a provider who maybe knows a lot more and specializes a lot in uterine abnormalities, I would love to chat with you and discuss a podcast episode in the future. Thank you guys!

Closing

Would you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan’s bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.

If you have a hard time interpreting your OP reports, try reaching out to your provider for clarification. You can also send us an email at [email protected] where you can schedule a one-on-one consultation with Meagan for extra help and encouragement!

How to VBAC: The Ultimate Prep Course for Parents

Full Transcript under Episode Details 

Meagan: Hello, everyone. It is Meagan today. We are going to be talking about OP reports. What is an OP report? Why do we want to get an OP report? How do we get an OP report and how long are OP reports available before they go away?

We do have a Review of the Week so we are going to get into that and then I’m going to go over OP reports. This review is from Brittanyhenley9478. She says, “Such an amazing resource.” Her review says, “I am pregnant with my second baby and will try for a VBAC in 4 months. Since finding this podcast, I have learned so much and gained a lot of confidence in my decisions. I’m so thankful for the podcast, their Instagram, and the website. I can’t wait to come back and share my successful VBAC story with them later this year.” 

Brittany, if you are still listening to us and you are still with us, let us know how your birth went. I hope that it was amazing and thank you so much for your review. You guys, I say it every single week multiple times a week now, we love your reviews. I seriously love them so much. It makes me smile. It makes my heart so warm so if you have not yet left a review, would you mind doing that for me? I would love it and appreciate it so much. You can go to wherever you listen to your podcasts and leave us either a rating or a review. I know Apple Podcasts and Spotify actually I believe, allows you to do a written review or you can Google “The VBAC Link”. Remember VBAC is V-B-A-C, and then you can leave us a review there. That also helps people find the podcast, find the website, the blog, and even our Instagram account. 

As a reminder you guys, if you are just listening to the podcast, hello. Welcome. I am so glad that you are here but I also don’t want you to miss out on all of the other amazing resources that we have. We have our Instagram account and Facebook account. We have a private Facebook group. You can look that up at The VBAC Link Community on Facebook. You do have to answer some questions so answer those questions and then we can let you in. It is such a beautiful space with people who are really in the same place as you– wanting to know their options, wanting to know the evidence, and wanting to feel that community love during this journey. 

We have a YouTube account and we do have our blog and our website and we also have a course. You can find all of that at thevbaclink.com. You can enter in your email there. We can put you into our subscription where we send weekly emails on updated blogs, updated studies, tips, resources, and all of the amazing things that we feel is really important for you to know during your VBAC journey. Again, you can find that at thevbaclink.com and of course, you can check it all out for free and again, enter your email in and we will make sure to get you those weekly emails. 

Okay, I’m going to go really quickly today but I really feel this is such an important thing to know. It’s not something that I one, knew was even a choice that I could have or two, was something that I should do so I could really learn more and understand more of what my provider was saying about my births and the reasons why the births happened with my body and my post-recovery and all of these things. It’s so good to know what they are saying about your procedure and your Cesarean, your birth. 

So okay. Steps to get OP reports. There are multiple ways and I know since I started requesting my reports back in 2015, it has changed a lot. A lot of people have an online portal with your provider where you can get your labs and a lot of these things. A lot of the times, their OP reports are included in there or there is a little drop-down option where you can request your OP reports. So if you have that, I highly suggest trying that or you can call your provider and ask for your medical records and your OP report. 

Sometimes they don’t really have them and they don’t want to give them to you so they may make you go to the medical records department in the hospital. Now, that is what I had to do. I called my hospital that I gave birth at. It was the same hospital for both of my babies so if you have to go to multiple hospitals, definitely make phonecalls so you’re not running around. 

Give them a call and say, “Hi. I really want to request my OP reports. I’ve had a Cesarean. What do I need to do to get those?” For me, I had to go in and request them with a form. It took about 5 minutes. It was really quite quick and easy and it took about 15 minutes to print them out. They did give me a hard copy which I loved having so I could highlight and write down and everything. 

But these forms are so important for you to have so you can understand and then for me, I did it before I was pregnant and I used it so I could have this form with me as I was going to find my supportive provider so they could have a better, deeper understanding of what was said about me and my body and my reasoning for a Cesarean. 

I want to give you a little bit of a warning. Sometimes you’ll find different reasons from what you were told and that can be very frustrating so just a heads up there. 

Another thing that is important to remember is that every state is different. They don’t just have these medical records saved on file forever. Here in Utah, I was told that it was 7 years. I know that it varies all around. I know Arizona is 6 years. New York, I think, is 6 years. Florida is 8 years. California and Utah, like I said, I think is 7 years. So definitely get your records as soon as you can. Now, I know most people are having babies anywhere from 1-5 years apart but I do think the sooner the better you can get these records is just better. 

So again, check out the portal. Call your provider. Go to medical records. Do whatever you can to obtain these OP reports and if you have a hard time understanding them, they have all of these weird things in there, don’t hesitate to reach out to your provider and say, “What does this mean? What did you mean by this?” I have also done one-on-one consults with many people to go over and process their medical records and help them come up with a path for what their next step could be for their future births and VBAC. I’m no medical professional by any means but I have been doing this for years and love doing it so if you would like to learn more about a one-on-one consult, you can email us at [email protected]. I would absolutely love to chat with you. 

Okay, everybody. Like I said, it was going to be short and sweet, but I really, really think it is important. If you are preparing for your VBAC, put this on the list of things to do. If you have just had a Cesarean, put that on the thing too to request. You don’t even have to look at it right now. It’s something you can have and put away but I do believe so much that it is important to have these and understand what our providers are saying and writing down about us. 

Okay, everybody. We’ll talk to you later. 

Closing

Would you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan’s bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.