Expert: Catherine Beier MS CBE - 7/17/2009

Question
I'm 37yrs old and expecting my first child. Feb 2006 I had an abdominal myomectomy to remove fibroids as well as a laparoscopy for severe endometriosis and a hysteroscopy. I have not had an ultra sound since my surgery and I'm not sure if any fibroids or endometriosis has returned.

I would like to have all natural childbirth, however the paperwork from my endocrinologist recommends having a c-section. I fully believe this is only because doctors feel obligated to recommend in case of complications.

Since I have to go to a new OB for my first prenatal visit I would like to bring a list of questions with me along with any facts supporting VB after a myomectomy. I do not want to put the life of this child at risk nor my own, but feel very strongly about natural childbirth if at all possible. Any advise or recommendations would be greatly appreciated.


Answer
Christine,


A vaginal birth after abdominal myomectomy may be a possibility, but that will depend upon the number, type, and location of the incisions used as well as the method of repair.


Healing time is not an issue since it's been over 3 years since the surgery.


You are correct that the standard recommendation after all abdominal myomectomies is a c-section.  There's a gaping lack of research in this area because abdominal myomectomy isn't performed often and it varies so much from woman to woman on the extent of the surgery.


So, since little information is available, most endocrinologists place a blanket recommendation for c-section rather than looking at options on a case-by-case basis.


My best recommendation is to interview a variety of doctors, bringing along a copy of your surgical report that documents the extent of your surgery.  You can ask the pros/cons of vaginal birth in your case and why or why not that particular provider will support you in attempting a vaginal birth vs. scheduling a c-section.


I would first look for providers who are supportive of VBAC, or vaginal birth after cesarean section, as these doctors will tend to be more open to your individual circumstances than a doctor who always opts for surgery.  To find a supportive provider in your area, you can contact your local chapter of ICAN, the International Cesarean Awareness Network (ican-online.org).



Best,
Catherine