By Diana Korte
Issue 89, July-August 1998
You might be wondering why I've included information about nonhospital VBACS when the possibility of uterine rupture exists. The answer is that there will always be reasonable women who choose to have VBACS in out-of-hospital birth centers or at home.
The fact is that there is less than a 1 percent chance of uterine rupture.1 (When obstetrician Bruce Flamm--a leading VBAC pioneer--and his colleagues evaluated the VBACS of 11,000 women in southern California in 1994, the rupture rate was .5 percent.) Thousands of women have had VBACS in homes and birth centers, sometimes after multiple cesareans, with no problems whatsoever. But when a rupture happens, a cesarean must be performed within 30 minutes. A 1993 California study found that to avoid any neurological damage to the baby, the cesarean should ideally take place in 17 minutes or less.2
Sometimes women who give birth at home or in birth centers erroneously believe they can't have a rupture because they are not using Pitocin or prostaglandin gel. Although a rupture is more likely after labor is induced with one of these products (or speeded up with Pitocin), some ruptures have developed without the use of either. In Arizona, California, Colorado, and probably elsewhere, babies have died in homebirths because of uterine ruptures.
Some women who plan nonhospital VBACS choose birth centers that are only a few minutes from hospitals. Others arrange to labor at friends' houses that are quite near hospitals. A few even take nearby motel rooms. While pursuing the benefits of VBAC outside a hospital, these women also take steps to reduce the risks.
(1.) Bruce L. Flamm, "Once a Cesarean, Always a Controversy," Obstetrics & Gynecology 90, no. 2 (1997).
(2.) Anna S. Leung et al., "Risk Factors Associated with Uterine Rupture during Trial of Labor after Cesarean Delivery: A Case Control Study," American Journal of Obstetrics and Gynecology 168, no. 6 (1993).
Diana Korte is an award-winning women's health writer and public radio producer. She is the author of The VBAC Companion (Harvard Common Press, 1997), Every Woman's Body (Ballantine Books, 1994), and the coauthor of A Good Birth, A Safe Birth, currently in its third edition (Harvard Common Press, 1992). Diana and her husband, Gene, live in Boulder, Colorado, and have four adult children and three grandchildren.
Adapted from The VBAC Companion: The Expectant Mothers Guide to Vaginal Birth After Cesarean, by Diana Korte, Harvard Common Press, 1997.