pregnant too soon, rupture risc 4.8% ???

[claudi81]

I wrote the post absout falling pregnant 7 months pp now I did some research and got a bit upsetting news

OK like some of you know we are planing on moving back to Europe (Germany), I already started looking into providers and their stats...I am not amused I just found a stat that the Obstetricians rely on in regard of VBACs and it says that...rupture risc of one a vaginal birth after two c-sections compared too one is not significant, 1.1% compared to 2% which is a good thing.

But here is whats gonna haunt me again...the stats also say that the rupture is increased depending on how much time is between the last c-section and the next birth. It puts me at a pretty high risc, what do you think??

Here are the stats, sorry they are in German, but you can tell by the numbers..LOL... What do you guys think?? 4.8% as in less than 12 months between pregnancies that is high right?? Not sure what I should do now Any advice??? Or thoughts, not 100% sure if I fit in the 4.8% or 2.7% but its much higher than I thought now arrrrr so frustrated I am not sure if I want to risc that much

Here this what I copied from the German Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG)

Ruptur nach wiederholtem Kaiserschnitt (RUPTURE AFTER RCS)
= 2 x Sectio 2 % vs. 1.1% nach 1 x Sectio (kein signifikanter Un-terschied) NO SIG DIFFERENCE (III, 6)
Ruptur nach Abstand zur vorausgegangenen Sectio /RUPTURE TIME SPACE TO LAST C-SECTION
< 12 Monate: 4,8% (IIb, 11)
13-24 Monate: 2,7% (IIb, 11)
> 24 Monate: 0,9% (IIb, 11)

[Defenestrator]

Well, the time counted is from birth to birth, so if you got pregnant at 7 months postpartum, you would give birth at 14-16 months postpartum, right? So the rupture rate would actually be the second number, 2.7%.

That is, if you trust the stats at all. The rupture rate of the third stat, .9%, is higher than the rate that is usually used for VBACs in general, which is .5%. Also, you have to take into account that the second stat, or really all of the stats, might include women who are higher risk then you (like women who have had many babies or women who are not healthy).

[claudi81]

thanks you for your post, that makes sense what you are saying...I always wonder about that some woman may heal different than others and may be more at risc than others too....I never had any problems and left the hospital 24hr later with ibuprofen only. My ouside scar looks great...not sure if that means anything, but I am hoping that it at least means I do not heal quite bad and may not be the worst candidate if there is a case like that.

I am not sure anymore if they are talking about 18 months between births or before trying to get pregnant, or as in the stats 12 months or less between pregnancies or births, but I been reading that your scar heals while you are pregnant too so it must be included

[MissE]

I have read somewhere that it is believed that the c/s scar is as strong as it's ever going to be at about 6 weeks after surgery. You either heal good or not. My OB tried to tell me that my scar wasn't good because I had a c/s at a military hospital. I don't think my body cared if I had surgery at a military hospital or not.

Anyway. I don't really have any information. My mom works as an OR nurse at a - German - hospital and she said that they usually section after two previous c/s. I don't know what other options you have in regards of midwifes or homebirth in Germany. I have had two children in the US and everybody I know who had kids in Germany (classmates, friends etc) always went with an OB.

Good luck.

[Lynann]

I had an emergency c-section after a failed homebirth two months ago. I asked about the safety of getting pregnant again quickly at my postpartum check up, and the OB told me that the c-section is considered completely healed after 3 months, so after 3 months it doesn't matter how long or not you have another baby.

The thing about stats is that they can be made to say whatever you want them to depending on how they are compiled and how they are interpreted. Stats that include random samplings of all types of pregnancies, but that doesn't break that down further are pretty meaningless, only stats based on your type of circumstances over a large sampling would be meaningful, but still not an absolute predictor of how it will work for you.

Don't let the stats discourage you. Hope you get the VBAC you want and it all goes smoothly.

[claudi81]

yes OBs are the ones that usually deliver the Baby in Germany, however midwifes are in every hospital for your whole labor support etc..so basically the OB mostly catches the Baby, does Vaginal surgery or c-sections...otherwise midwifes controll the L&D to 90% in every hospital which is great, eventhough they may be soo busy and cut short that they can not give you much 1 on 1. Therefor they have midwifes that do the before and after care of a mom and in some cases those midwifes do stay with you for the delivery of your baby in a hospital or do homebirths.

I know that they also have new guidelines in Germany for OBs that say a VBAC after 2 c-sections is not much more of a risc than a VBAC after 1. So they begin to change a little, not sure how many hospitals have implemented these guidelines.

If I do not find any provider/hospital that is willing to support me with a VBAC, I will be screwed cause my husband will never be on bord with a HBA2C if this option is even given to me.

[GinnyMama]

I've only read the original post, but absolutely reglardless... I would try for a VBAC. If we were talking about UBAC, it may be different, depending on your personal beliefs. But if you are in a hospital, if something should happen, then they have you covered. I was in the .5% risk of rupture, and yet I did. And I was UBACing. I was at home, and my uterus ruptured. I went to the hospital, and they gave me a section, and both my son and I are healthy and happy.

Although I do not agree with it... I *understand* OBs pushing repeat c-sections... for whatever reason. However, I do NOT agree with OBs pushing a repeat c-section if you are planning in delivering in a freaking hospital. Arguing for c-section vs. UBAC.... I don't agree, but I get it. Arguing for repeat c-section vs hospital trial of labour? Absolutely not. It's ridiculous.

[roadfamily6now]

for what it's worth, I have never seen stats that high in relationship to U/R .

And on a personal note, my first VBAC was just 14 months after my c-section.

[AustinMom]

Of what I know when talking about the time between CSs and VBAC it's exactly that, the time of birth between birth, not birth to pregnancy, so yes, you would be in the second grouping.

Now, according to the NIH, they say that rupture rate is less than 1% for a mom VBACing 18 months between births, much lower than the stat listed. I am assuming, but I *THINK* the US is probably more likely to use induction and augmentation vs Germany, so I would venture to guess that the VBAC rate for your case, with your timeframe would be even less than that.

Personally, of what I have read it's about 42 days from suture to healing, according to Vaginal Birth After Cesarean. You may want to check that book out, it's pretty good and goes over rupture pretty well.

I wouldn't worry about complications with rupture, especially if you are in a hospital like a PP said. I think it's something like 0.05% of the time a VBAC is dangerous for the baby as in life threatening. So I wouldn't worry.

[claudi81]

Thanks for your support Ladies it encourages a lot!!!

I do not know if it became clear, but I had 2 c-sections and no vaginal birth

So from the 2nd c-section to the next birth will be 15-16 months...most doctors feel different about having had 2 c-section but on top of it the short time frame I will have to fight my butt off to get the birth and support I want!

Its just last time when I was going for my VBAC I was not worried about a rupture or any problem at all. Why is it that I feel so anxious this time?? It seems like its so much harder to fight for it this time not sure why there are so many stats that say its more of a risc after having two c-sections and less time between birth