Updated: Jun 7, 2019
While I was preparing for a VBAC after my first cesarean, I started being asked a question that I didn’t understand at first. Providers would ask me, "What type of scar do you have?" I wanted to reply "Well... a Cesarean scar?... What other kind of scar would I have?" As my knowledge grew on VBAC and C-sections, I learned that there are actually four types of incisions, the most common is the low transverse scar, also known as a bikini cut. The majority of women have this type of incision. Those who don't, however, face specific challenges to get acceptance for TOLAC.
What is a Special Scar?
A special scar is an incision made other than a low transverse incision. There are three types of special scars. These are:
Is an incision that can be done anywhere in the middle of the uterus. Although. classical incisions are not as common they are still being done today with breech babies or preterm babies.
T and J incision
These scar types happen when a surgeon needs more room to get the baby out after they have done a low transverse incision. The look like a "T" or a "J". Sometimes they happen on accident as well. These scar types are rare.
Low Vertical Incision
A low vertical incision is made in the lower part of the uterus. These incision types are used when the baby is large, transverse (sideways), or for placenta previa. If the scar extends far enough up into the uterus, it might increase the chances of rupture. In the cases of a premature delivery it is likely to extend higher. Current ACOG guidelines as we talk about in the next section, allow for TOLAC with a low-vertical incision.
Can Special Scars VBAC?
Studies show that women laboring with special scars have no significant increase in chances of rupture, most notable studies show chances of less than 2%. However, in ACOG’s 2017 Bulletin they do not recommend TOLAC for those with classical or T or J scars however, low vertical scars are ok. They do specifically note that “individual circumstances must be considered in all cases.” (ACOG, 2017).
It is important to know if you have a special scar and what type it is. The best way to do this, if you do not already know, is to get your operation report from the hospital that you delivered at by contacting the records office. Ask for your operative reports and if you have had multiple cesareans be sure to request reports for all of them. Take these with you to your visit with your VBAC supportive provider and discuss what options you feel is best.
Having an educated discussion with your provider will help determine what direction is best for you and your baby. Honestly, it can be hard to find a supportive provider who will share the facts with you and agree with your choices. If your current provider does not have views about your options that align with yours, it is OK to switch providers and interview more until you find who best fits with your birth goals. Check your local ICAN group and ask for suggestions on who might be the best fit for you!
-To find more information on special scars visit specialscars.org
-To join the Special Scars FB group, you must have a special scar. Like the Special Scars Facebook page and message the admin to be added to the group.
Check out episode 17 on our podcast for a story about Leslie and her VBAC after being told her special scar made her a "ticking time bomb" for rupture.
Episode 32 shares Bronwyn's story of a VBAC after a special scar and has such a wide range of birth experiences it will inspire anyone!
The mind is a powerful birth tool and can affect so many things in the body. Download our free fear release activity to use to clear your mind and release your fears for birth.