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How common is uterine rupture?

post #1 of 35
Thread Starter 
Hi! I usually lurk around here, but i have a question...My husband heard a horror story so I promised I'd look into it as we are planning a hbac. How common is uterine rupture and what can you do about it if you're not at the hospital yet? We live 15-20 minutes away from the hospital. Any good sites for statistics and/or reassurance? Thanks!
post #2 of 35

I had a VBAC and was told by the midwife all the risks. Less than 1% of all births end in uterine rupture, and the previous C Section makes that percentage go up another percentage point. So 2% risk.

 

It's kind of a scary ruse that docs use to control birth, if you ask me.

post #3 of 35

Not even. It's 1 in 200 for an un-induced, un-augmented VBAC (0.5%)--some studies are a little higher, but all under 1% and some may have lumped in pit-augmented labors. Risk goes up a little bit with augmentation, more with pitocin induction (I think just under 1% with induction). Prostaglandins (Cervidil and Cytotec) raise the risk much more, which is why they are almost never used. If your only choices were a prostaglandin induction or a repeat CS (say you developed a medical issue at 37 weeks, cervix totally unripe, and delivery could not wait) then the RCS would be safer in that scenario.

post #4 of 35

Yeah, not even.  The risk of uterine rupture among 'all women' is FAR less than 1%--very rare in a reasonably healthy women.  UR in women with no uterine scarring is very, very, rare, and is usually associated with using cytotec or excessive amounts of pitocin.

 

go to www.ican-online.org and you will find a ton of well-researched info on csec, repeat csec, rupture and all the risks of repeat csec.  ICAN is the International Cesarean Awareness Network.  They have support groups all over the place, and you may well find one near you--a great place to find info and support for vbac!  The website can help you find local support groups.

 

Also, you should know that while it's true that in normal/uninduced labor, rupture rate is .5% (1 in 200), the great majority of these ruptures are very minor and not life-threatening to mom or baby.  Go to the ICAN site for best info.

post #5 of 35

Not all ruptures are catastrophic, either. I forget the exact number but it was something like 5% of ruptures result in death or damage to the baby - so 5% of an already low 0.5% rupture rate - a very small number statistically (I think the numbers are from the Childbirth Connection website but I got them second hand at a presentation so it may pay to do your own research). 

 

I have found ICAN to be enormously helpful. 

 

I also believe in following your gut instinct when it comes to birth. You take in all the information and make the best decision for *your* family even if others disagree. The important thing is to be informed and to listen to your inner voice.

 

post #6 of 35

Yep...there is about a 99.5% chance you uterus will hold up just fine. thumb.gif

post #7 of 35

http://www.ican-online.org/vbac/uterine-rupture-a-10-year-population-based-study-uterine-rupture 

 

 

The rate of rupture is less than 1%.  It's 7-8 per 1000 births.  That number includes dehiscence  up to a complete rupture.  complet rupture accounted for 3/1000 and dehiscence 5/1000.  Induction or augmentation of labor with oxytocics was associated with 50% of complete ruptures and 25% of dehiscence .

 

sooooo, Your risk of complete rupture with a home birth (without artificial oxytocin) is about 1.5 out of 1000.  Right about the same for dehiscence...which in and of itself is not dangerous....(*dehiscence is a thinning of small seperation the uterine wall* also known as a "window")

 

*if* a rupture happens at home, you are in trouble.  It is an urgent situation.  Only you can decide if you want to take that risk.  That being said, the risk of complication from repeat c/s is far greater from almost every angle.  VBAC has been proven safe and yes, safe at home.  I had some other risk factors and the option of a fantastic OB who lifted me up and encouraged me in every possible way.  I don't know what I would have done if HE hadn't been an option.

 

You are more likely to have a car wreck on the way to the hospital than have a uterine rupture.  

post #8 of 35

What I found particularly interesting while we interviewed homebirth midwives recently is that unscarred uteruses have a rupture rate of .3%, and scarred uteruses (unmedicated labor) are .5%. Not much difference to me, and it essentially puts the risk where it should be (extremely low). There are other birth complications that are more likely, and even those are considered rare.

 

ETA: thanks for correcting me on this, I am going to ask my midwife where she got that number. I was not able to find anything to support it (in just a quick search during lunch), once some posters following this said the unscarred statistic is NOT correct.


Edited by CookAMH - 1/26/11 at 4:00pm
post #9 of 35
Quote:
Originally Posted by CookAMH View Post

What I found particularly interesting while we interviewed homebirth midwives recently is that unscarred uteruses have a rupture rate of .3%, and scarred uteruses (unmedicated labor) are .5%. Not much difference to me, and it essentially puts the risk where it should be (extremely low). There are other birth complications that are more likely, and even those are considered rare.

 

Research shows about a 0.01% chance of UR in an unscarred uterus.
 

post #10 of 35

Yes, rupture rate in unscarred uteri is VERY low, as GOPlawyer notes.  Not sure if your hb mws were spouting wrong facts, or maybe you just misunderstood the numbers they spouted. 

post #11 of 35

I think it is very important not to understate the risks of VBAC.  It is also very important not to overstate the risks.  Uterine rupture is a risk of VBAC, but as PP state, valid studies put the risk at around 1%, relatively low.  I think what is difficult about the decision is not the numbers.  The stats have shown over and over VBAC is a safe option for most women.  The difficulty is going against medical/societal opinion.  There are risks to RCS, serious ones.  But if something goes wrong during or after a c-seciton, there is someone else to blame.  The doc recommended the section.  But if something goes wrong during a VBAC, something you chose to do, then the perception is, it's your fault.  I am not saying this is right or I agree with it, but it is tough going against societal norms, especially the one that thinks docs know best all the time.  When there is an article online about VBAC, there is always a comment about "how could she not do what the doctor recommended?  He's been to medical school, she hasn't" even though it was a successful VBAC.  Your husband is probably afraid of the unknown, I know mine is.  I ask him, "Would you be less sad if I died on the OR table or would you wonder the rest of your life what would have happened if you had supported a VBAC?" 

post #12 of 35

Are there any specific studies on HBACs?    also...can anyone send me links to studies proving the safety of VBAC?  My sister is a nurse and she is trying to tell my parents (and my husband)  that i am completely bonkers for wanting an HBAC.  My mom even said to me, "What color would you like your coffin?"   I need for them to support me, i don't want the stress of their lack of support to make it difficult for me to get pregnant or make it difficult for me to labor in the future. I tried to find HBAC studies for my sister and ended up looking like an idiot. I found nothing from google...hope there's someone out there that can help!

post #13 of 35

There are no specific studies addressing it, and I don't think there will be in the foreseeable future. There are two issues:

 

1) Legal and ethical (since it's known that IF you rupture, rapid access to an OR is important--so it would pose issues for any study authors).

 

2) Logistical. There just aren't that many HBACs. About 4% of VBACs in my state took place outside a hospital. That's 4% of an already small number. You'd need to enroll every potential HBAC in the country to get a statistically meaningful result. Other countries aren't much better. The UK NHS discourages HBAC and the Netherlands does not permit midwives to attend them. Canada does, and VBACs (1 C only) were included in the overall results for recent home birth studies in Ontario and BC, but again, the numbers were small. Even if it did have an increased level of risk it might not have shown up. If you only have a few hundred women, you can't draw any conclusions--having 4 women rupture instead of 3 could be a fluke. The totals don't say anything meaningful about HBAC safety because they were a small proportion of the overall numbers. On top of that, there's the issue of generalizing from foreign studies--transfer in particular, which can be difficult in the US. You would also want to get women who were otherwise low risk, which would further reduce the potential numbers.

 

So - HBAC is neither proven safe, nor proven unsafe. We don't have good evidence.

post #14 of 35
Quote:
Originally Posted by neveraim View Post

 

You are more likely to have a car wreck on the way to the hospital than have a uterine rupture.  



While I am absolutely agreeing with the spirit of this thread, the above statement isn't likely to be literally true. 1 in 200 trips to the hospital (or trips anywhere) do not end in a car wreck. 

post #15 of 35

gah.  You are absolutely right!  Sorry!  I got carried away!


Quote:

Originally Posted by jeminijad View Post



Quote:
Originally Posted by neveraim View Post

 

You are more likely to have a car wreck on the way to the hospital than have a uterine rupture.  



While I am absolutely agreeing with the spirit of this thread, the above statement isn't likely to be literally true. 1 in 200 trips to the hospital (or trips anywhere) do not end in a car wreck. 


You know...there are all kinds of variables to how and why a uterus would rupture.  There is a need for some real studies to be done so we can quote real numbers.  I remember when I was researching, years and years ago, the majority of uterine rupture cases and especially catastrophic rupture, occured in conjuction with artificial oxytocin.  These ruptures include ALL women, women who don't take care of themselves, women who are not involved with their healthcare decisions, women who don't get prenatal care, and yes, women like us who question, who eat right and excercise, women who go to yoga and chiropractors.  Who really knows what all the variables are leading to a rupture.  I believe it's more than just prior c/section.
 

I felt healthy and good and I felt like my body could do it.  I advise you to follow your gut...If you don't feel safe, don't do it...but educate yourself about it.  Don't just rule it out on fear.

 

I've had a few car wrecks in my life....and honestly...I'm probably more likely to get in a car wreck than have uterine rupture!!  That certianly doesn't go for everyone! 

post #16 of 35
Quote:
Originally Posted by April420 View Post

Are there any specific studies on HBACs?    also...can anyone send me links to studies proving the safety of VBAC?  My sister is a nurse and she is trying to tell my parents (and my husband)  that i am completely bonkers for wanting an HBAC.  My mom even said to me, "What color would you like your coffin?"   I need for them to support me, i don't want the stress of their lack of support to make it difficult for me to get pregnant or make it difficult for me to labor in the future. I tried to find HBAC studies for my sister and ended up looking like an idiot. I found nothing from google...hope there's someone out there that can help!


My family is not supportive either.  My advice, stop trying to convince them.  Unless they are as passionate as you are, they will not put in the time to really research VBAC.  The comment your mom made really steamed me.  You are more likely to die during a RCS than a VBAC.  I posted the link that has that info.  BTW, I am an RN, worked in Med/Surg and ICU.  I understand where your sister is b/c I was completely immersed in the medical model and trusted that my OB would practice evidence-based medicine.  Only after my section and VBAC attempt did I start to look at the research myself.  There may not be specific studies on HBAC, but there are studies supporting VBAC as a safe option.  ACOG, American College of Obstetrics and Gynocology, just revised their standards of care b/c they finally looked at the evidence.  NIH, National Institutes of Health, has also released a statement that VBAC needs to be available to women and the current reasons it is being denied are not good enough to unnecessarily subject women to major abdominal surgery.  I will be attempting an HBA2C, hopefully, next spring.  I am willing to accept the risk b/c there is only a very small chance that something will go wrong at home.  I am not willing to accept the risks of a third c-section and I am not subjecting myself to unneccessary intervention that increases my chance of having another c-section, so home it is.     

 

http://givingbirthwithconfidence.org/2-2/a-womans-guide-to-vbac/weighing-the-pros-and-cons/

 

P.S.  On another post, I think it is one about VBA2C, I posted links to studies if you want to take a look.  HTH!
 

post #17 of 35
The risk is very low, its pretty rare to have a serious rupture. The reason people worry (myself included) is because it is one of those compilations that can actually kill both mama and baby- there aren't many complications that can do that (eclampsia is another, as you can stroke out). If it does happen, there's a good chance of a tragic ending. At home you may not have time to transfer. That said, the overall risk is so very low, even knowing this, it's reasonable to take the chance that you are the 99% not the 1%. Even Dr Amy supports VBAC, and delivered them when still practicing!

The reason VBAC is avoided by docs and hospitals in USA IS NOT because they don't want to do them, as many OBs think VBAC is a good option. The problem is that when a rupture does happen and someone dies (if you do enough VBACs, it will happen eventually), they SUE and the doc/CNM/hospital loses every time. In one well known case, a VBAC momma ruptured and her baby died- in the hospital- and she SUED AND WON. She had discussed the risks very clearly, and signed a consent form, but then she argued that there is no way she could have truly been informed. She admitted her doc gave her all the facts, but she said she just didn't understand what that risk was. Her lawyer proved that she wasn't capable of analyzing the risk!!! This kills informed consent, as they basically said that no matter how well informed she was, she just couldn't be informed enough as a layperson!

EVERYTIME a doc or CNM loses a baby or mama, or both, to something that could have been prevented by a CS, they LOSE when sued, even if that mama refused the CS. If a Cs wasnt done, for ANY reason, they lose their case. period. Because of this, many providers are gun shy, for good reason. Why would you risk your career, that you put a decade of schooling, tons of money, and blood, sweat and tears, to do VBACS or avoid CS if one wrong outcome (even if it's not your fault) can ruin you?

THIS is why VBAC is avoided- because of legal reasons. In USA, docs and CNMs must carry malpractice insurance until their last patients baby is 18 years old!!! Losing lawsuits to mamas that chose to VBAC or forgoe CS can make the insurance so expensive they are forced put of practice, and this is a very real fear. being forced out when you are negligent is one thing, but losing your career because you did what your patient asked is very different. They are also banned from some hospitals because they require more docs, OR space, anethesiolgists, and other stuff on stand by, to mitigate the chance of rupture, and not many hospitals can provide these things.

I know my doc suggested a VBAC for my next baby,.My cousin had a VBAC this year, as well as another friend, so some providers will still do them. just don't assume the ones who don't avoid it because they think it's a bad idea, when most don't. (It might depend whe you liver though).
post #18 of 35

One thing we could argue for the safety of home birth , though , is , that if they were so dangerous and high-risk and so much would go wrong with them , then surely we could find plenty of material against home birth , since I can imagine , that the people against them would jump on every home birth gone wrong  they can find .

I have to really agree with Neveraim , the studies , that were done for vbac and vbamc included every vbac mother , including the ones induced , the ones who were morbidly obese(no offense) , the ones with other medical issues , the ones , who delivered in some backyard shack w/out medical care and so on , so I personally really believe , that the risk for a healthy mother , who has received proper medical care , has avoided heavy lifting in order not to put extra strain on her scar and so on and who is going into labor by herself and gives her body the time it needs to dilate as slowly or quickly as it needs to , then the risk is probably miniscule and it definitely beats the short- and long-term risks involved with a RCS .

Honestly , I heard those stories too , when I was pregnant with my third son , after 2 cs (one unnecessary) , but I chose to ignore the bad ones and only focused on the positive ones , and I delivered a perfect baby after 4 days of really  gentle contractions , that slowly opened my cervix and then towards the end I went from 7 to 10 cm in a few minutes and he popped out like a rocket . I absolutely believe , that my body needed that time , it knew , how to best behave . You just have to trust your instincts , I was lucky to have a supportive hospital , but I would not have let them tamper with me if they wouldn´t have been , and it worked .
Believe me , it was the best feeling I ever had and it was sooo worth it , plus the way I look at it , you can try and then you have a chance to succeed and that chance is quite high or you can have a RCS and then your chance to succeed is 0 % , so I´d definitely give it a fighting chance .

I know , I will be going for a vba3c next time I´m pregnant , and nobody can talk me out of that thumb.gif, especially since the rupture risk is sooo tiny .

And cesarean is MAYOR SURGERY , which some people seem to forget , when they give you the option of "you can either go the safe(?) route of cs or you can endanger your life and that of your child and go into labor , trying for a vbac "

Sorry , this is kind of long , but I really needed to vent that , this whole issue is kind of a sore spot for me winky.gif

post #19 of 35

I was lucky enough to go to a lecture by Henci Goer once, and she presented this stat (among many, she is the stat queen!) that made a big impression on me. Data show that 1 in 10,000 attempted VBACs results in a rupture that causes death for the baby. But about 1 in 10,000 planned repeat c-section results in death for the mother. Both are small risks, but they're also equal risks. Somehow we hear a lot about babies dying from attempted VBACs but we don't hear about moms dying from sections.

post #20 of 35



 

Quote:
Originally Posted by wingsmith View Post

Hi! I usually lurk around here, but i have a question...My husband heard a horror story so I promised I'd look into it as we are planning a hbac. How common is uterine rupture and what can you do about it if you're not at the hospital yet? We live 15-20 minutes away from the hospital. Any good sites for statistics and/or reassurance? Thanks!


Hey there- I remember when planning my HBAC two years ago I was terrified... it's totally natural to have fear, you know? I am due anyday now with #3 and am having some of the same fears pop up!

 

This site was very helpful to me: http://vbacfacts.com/

 

More VBAC facts: http://vbacfacts.com/vbac/

 

And specifically about HBAC: http://vbacfacts.com/hbac/
 

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