What my next doctor needed from my operative report
Nine months after my cesarean, a gynecologist reading my records told me things about my surgery I hadn’t known. This is how I chased my own records, and why your operative report matters for your next delivery.
Chasing my own surgery
The early questions. In the months after my first birth, I started asking about having two children close together, and how long to wait after a cesarean. A few months later, I asked whether the keloids on my scar (thick, raised scar tissue) meant there might be scarring inside, and whether that could affect another pregnancy.
The visit that started the process. I had gone to that nine-month visit with the gynecologist about a painful lump under my scar. I brought written notes, and the gynecologist ordered imaging, made referrals and started the referral process for a preconception consultation with maternal-fetal medicine, the high-risk pregnancy specialists. The gynecologist said my keloids and my cesarean after an induction that didn’t progress can be associated with high-risk pregnancies, and aren’t often discussed with patients after delivery. (“Working With Your Doctor”) One note even put my cesarean a decade earlier than it happened. It was a small typo, and a reminder to read your own chart.
Chasing the records. Three months later, I wrote asking the gynecologist to place the preconception referral and to send me the birth records used at that visit. I was sent instructions for requesting my records. I wrote again: the gynecologist had mentioned that someone from my birth team might walk me through the procedure, since my abdominal wall had split and I’d been given a steroid injection I hadn’t known about. “Would it be possible to help facilitate that?” I was told the high-risk team would reach out to schedule the consultation and could discuss the surgical details then. A month later, I followed up because no one had. I was offered appointments more than a year after the birth, with the same specialist who had managed my pregnancy.
Now. I’m pregnant again, and I’ve requested my full records: prenatal, delivery, operative, anesthesia, inpatient and postpartum. My questions have moved on to the delivery: whether my scar could have problems with no obvious symptoms, and whether a vaginal birth is possible for me this time. (“How I’m Preparing for My Next Pregnancy”)
Key points
- Most studies of a trial of labor after cesarean (laboring to try for a vaginal birth) report a 60% to 80% chance of vaginal birth, but your own chances and risks depend on your history. A prior classical incision, a vertical cut in the upper uterus, or a T-shaped uterine incision generally rules it out. Not every vertical incision is a classical incision. Request your operative report before your next pregnancy so your clinician can confirm which type you had.
- A trial of labor after cesarean should happen where staff are immediately available for emergency care, and some hospitals no longer offer it. Ask your hospital whether it does, before you choose where to deliver.
- New York’s Hospital Patients’ Bill of Rights gives you the right to review your medical record without charge and to get a copy for a reasonable fee. Ask for the records themselves, in writing, not instructions for requesting them.
Nine months after my first child was born, a gynecologist read from my birth records during a visit and told me my abdominal wall had split, and that I’d been given a steroid injection I hadn’t known about.
That is how I understood what the gynecologist told me. My records from the weeks after the birth list a “wound dehiscence,” a separation of the incision, and later notes describe a small area of wound separation that was packed. I still don’t know whether that is what the doctor meant, or whether it described something found during the surgery itself. I also still don’t know what the steroid injection was for.
I’d been asking about my next pregnancy for months. Now I had new questions about my first.
What the records decide
The operative report is the foundation. It contains details my next clinician needs to review with me. I spent months chasing my own records, so it’s worth knowing what the rules say. Under federal law, you have a right to a copy of your records. New York’s Hospital Patients’ Bill of Rights adds the right to review your medical record without charge, and to get a copy for a reasonable fee that can’t be denied only because you can’t pay.
Your skin scar doesn’t tell you about your uterus. The incision on your skin and the incision on your uterus can be different. The type of uterine incision, recorded in the operative report, is one of the key factors in whether a trial of labor after cesarean is an option. Many people with one prior cesarean are candidates. Whether you are depends on your history, and there’s a small risk of uterine rupture that your team will weigh with you.
Spacing has a guideline, not a personal timetable. ACOG advises avoiding pregnancy within six months of giving birth, and recommends counseling about the risks and benefits of an interval shorter than 18 months. Time from birth to your next conception and time from birth to your next delivery are different measures, about nine months apart. Make sure you and your clinician mean the same one.
How I keep my own records
- I request my records myself and keep my own copies.
- I bring written notes to every important visit, and send a recap afterward.
- I follow up when a promised call doesn’t come.
- I read my notes and ask for corrections when something is wrong.
The folder I carry between practices is in “Setting Up Your Care Structure.”
Before your next pregnancy
- Keep confirmed findings separate from possibilities. Ask what the records show and what’s still unknown.
- Ask about delivery options early, including what hospital resources a trial of labor requires.
- Plan preeclampsia prevention at the first visit, not the third trimester.
Because I had preeclampsia (a serious blood pressure condition) in my first pregnancy, I take low-dose aspirin this pregnancy, with my clinician’s approval.
Take this back
To discuss with your care team:
- What does my operative report show about my uterine incision and how it was closed?
- Was anything unexpected found or given during my surgery?
- Given my history, how long should I wait, and do we mean time to conception or time to delivery?
- Could I have scar problems I can’t feel? How would we find out?
- Am I a candidate for a trial of labor after cesarean, and what would make it more or less likely to succeed?
To discuss with the people in your life: Will you help me chase the records if I need to?
Next in the series: “Feeding Support Before You Need It”
