Expert: Catherine Beier MS CBE - 4/24/2009

Question
I had an abdominal myomectomy April 9th using the Da Vinci Surgical System. I had the five incisions in my abdomen, but I think there might have been just one cut into the uterus.  My RE did show me where she stitched the uterus back after removing the 3cm fibroid from the uterine cavity.  I think that I’m making an outstanding recovery.  She also mentioned that I have a small pelvis (don't know how much this matters) She recommends that I have a c-section in the future.  I am 37, very fit and healthy.  I have scoliosis, but no other major illnesses.  I try to stay away from medication and take good care of my body. I am a vegetarian. My question is: will I really need a c-section?  I would like to do things as naturally as possible. I am always trying to do my homework so that I can be an informed patient.  If you can point me towards some more info or recourses, I'd really appreciate it.

Thanks a bunch,
Mik

Thanks,
Mik  

Answer
Mik,

In terms of having a small pelvis, this usually doesn't matter and is not a reason in itself to have a c-section or even to suggest having one.

There is absolutely no research to support scheduling a c-section on the theory that a baby won't fit.  The only way to truly know is to have a trial of labor first and see how it progresses.


In terms of the myomectomy, it's entirely possible that you could be able to have a vaginal delivery.  Your fibroid wasn't that large and with only a single uterine incision, you should have a very good chance of a vaginal birth. The caveat to this could be how quickly after the surgery you become pregnant.  Typically, risks of uterine rupture are greatest when less than 2 years have passed between uterine surgery.  


So, in your case, it's mostly a wait-and-see process, depending upon when you get pregnant.  


Your best course of action is to explain your wishes to your provider and to locate one who is supportive of vaginal birth after myomectomy.  Many believe that a c-section is always the only option, which isn't really the case.  


Your best chance of having a vaginal birth will be to find a supportive provider.


Best,
Catherine