The Accuracy of Operative Reports

by Jessica Tiderman

“Why did my OB tell me that I had a classical incision but my operative report says that I have a low transverse?”  If I had a dollar for every time I've heard this, I wouldn't be rich, but I probably could take my family of 7 out to dinner at a really nice restaurant.

Even my own report says that I had an inverted T incision that “extends well into the fundus” in several places but only in one place does it actually give a measurement.  We have more than a few women who were told that they had low transverse incisions only to find out in a subsequent pregnancy that their report says something entirely different and vice versa.

How do you know what type of scar you have?

That is an excellent question and one that I've yet to figure out how to answer.  You cannot use your external incision as an indication of what your internal incision is, they don't always match and your external incision will have no bearing on any future birthing possibilities.  I usually recommend that people go with what the OB told them when they talked to them right after the surgery.  The doctor's mind is fresh, he hasn't done too many more c-sections yet and he will probably remember fairly accurately.  It might be a few more hours before he does the dictation for your chart, he might go into autopilot while dictating the notes for your chart.  We have no idea why these errors happen, but they do.  We know that there are errors because doctors will talk about a male baby when the woman had a female baby, the doctor will say there was a low transverse incision when the woman's partner sitting next to her clearly saw the doctor make a vertical incision.  Ultrasounds during pregnancy do not always show the scar very clearly.  I've heard about some doctors using MRI, but that also doesn't seem to be very accurate.  No one has done any big studies to find out which method is the most accurate.

Is there reason to panic?

That might depend on your care provider.  If your operative report says that you have a low transverse incision and you have reason to believe that you have a Special Scar, count yourself somewhat lucky.  You won't have the SS stigma that makes finding a care provider to assist you in a VBAC nearly impossible.  However, if your care provider starts talking about inducing you – you might want to seriously consider finding a new care provider.  No VBAC momma should be induced (in my opinion), but especially not a SS VBAC momma.  As far as we know right now, our risk of rupture is significantly higher than a woman who has only had a low transverse incision.  We also know that induction raises the risk of rupture.  Why add fuel to the fire?

What can you do?

Trust in your body and do everything you can to put yourself in the best possible position for a VBAC. Katie put together a good list of suggestions in her articles What Does It Take? and Finding a Care Provider After a Special Scar.