Risk of uterine rupture after many(6+) vaginal births, but no c-sections?

[Saramomofmany]

I am wondering if any of you knowledgeable midwives have any thoughts on this. I was told by my midwife(CNM-delivering at a hospital), that because I have had 6 vaginal births, that my risk of uterine rupture is the same as a mom that has had a c-section(even though I've never had a c-section). That being said, she said if I need to be induced(the past few births I have been induced due to pre-eclampsia one time, and PIH for another), that she would be unable to do the cervidil like we used with the last birth, she would only be able to do pitocin or breaking my water. Does this make any sense? I find it hard to believe that a uterus that has gently stretched 6 times, rather than been cut into would have the same risk of rupture. 

I really love my midwife, she's been with me for the past few pregnancies. I'm just wondering if this is something every midwife is going to have as a "rule" or if most don't. With my history of having inductions for my high blood pressure and/or pre-eclampia, it's a very real possibility of being induced this time(due in Sept). 

Thanks for your time. Sara

[cinderella08]

Hm.

I looked through all of my midwifery textbooks and nowhere can I find that multipara is significant when it comes to rupture with no prior c-section.

That being said - keep in mind even though your particular midwife is treating you as such, the risk for UR in a VBAC mama is less than 1%.  Very little.

The reason she doesn't want to induce with a prostaglandin is because there is a higher risk of UR than with a pitocin or AROM induction.

I have a pitocin induced VBAC with no issues.

PERSONALLY - I'd seek a second opinion, but that is just me.  That being said - I guess it truly doesn't matter because you say you may have to be induced regardless and going straight for Pit VS Cervadil is fine providing your cervix is favorable.

[Saramomofmany]

Thanks for your response Amber. I didn't realize there was a higher incidence of UR with a prostaglandin induction rather than w/ PIT or AROM. With my last birth, my cervix was not favorable for a PIT or AROM induction. My midwife wanted to use misoprostol/cytotec, and I had heard that was really dangerous for UR, so I had done some research and thought that cervidil was the lesser of the two evils. 

I would love to have a healthy, normal blood pressure pregnancy and NOT have to be induced. 

I am seriously considering getting a second opinion. I personally really like my current midwife, however, I've started to feel lately with her that I'm just a statistic waiting to happen(grand multipara, advanced maternal age, previous pregnancies with high b.p., etc). 

It's kind of hard to switch hospital though. Since I've birthed at the current one 3 times, and kind of know how things flow there...but if it ends up being I can get through this w A LOT less interventions, I'm all for it. I'm going to email a midwife that is an option at a different hospital, and see what she thinks about my situation. I'm trying to do what I can nutritionally also to see if that has any effect on my b.p. this go round. 

Thanks again. Sara

[babycatcher01]

Originally Posted by Saramomofmany 

I am wondering if any of you knowledgeable midwives have any thoughts on this. I was told by my midwife(CNM-delivering at a hospital), that because I have had 6 vaginal births, that my risk of uterine rupture is the same as a mom that has had a c-section(even though I've never had a c-section). That being said, she said if I need to be induced(the past few births I have been induced due to pre-eclampsia one time, and PIH for another), that she would be unable to do the cervidil like we used with the last birth, she would only be able to do pitocin or breaking my water. Does this make any sense? I find it hard to believe that a uterus that has gently stretched 6 times, rather than been cut into would have the same risk of rupture. 

I really love my midwife, she's been with me for the past few pregnancies. I'm just wondering if this is something every midwife is going to have as a "rule" or if most don't. With my history of having inductions for my high blood pressure and/or pre-eclampia, it's a very real possibility of being induced this time(due in Sept). 

Thanks for your time. Sara

Edited by babycatcher01 - 5/12/11 at 9:57am

[babycatcher01]

I would suggest the Brewers diet. In many cases pre-e and PIH nutrition plays a big role in preventing these two complications. If you can prevent the complication, then you wouldnt have to worry about induction.

www.blueribbonbaby.org 

[Saramomofmany]

Thank you for the suggestion. I have been reading about the Brewer diet for a while now, and am going to do everything in my

power to not have the PIH.  Sara
 

Originally Posted by babycatcher01 

I would suggest the Brewers diet. In many cases pre-e and PIH nutrition plays a big role in preventing these two complications. If you can prevent the complication, then you wouldnt have to worry about induction.

www.blueribbonbaby.org 

[jljeppson]

Definitely get a second opinion.  My mother had 8 kids, with a total of 10 pregnancies.  She's also been in the medical field for 40+ years and wouldn't agree with what your CNM has told you.  I just had baby #7 and had no worries about UR, and neither did my backup doc.

[sharita]

The only fear a lot of OB's have when it comes to grand multiparas is a lazy uterus after delivery so it wont clamp down as efficiently so they fear postpartum hemorrhage.  There is conflicting evidence on this though just like many risks.  I haven't ever heard of increased risk of uterine rupture though from a grandmultip.  Maybe with a cytotec induction that causes contractions so strong there have been instances of rupture so the thinking would be, grandmultip, thinner uterus, greater risk?  However, cytotec is no longer used for induction, just abortion and portpartum.  Id also get a second opinion.  Id have to ask for the research based evidence on this one.

[kawa kamuri]

Originally Posted by sharita 

The only fear a lot of OB's have when it comes to grand multiparas is a lazy uterus after delivery so it wont clamp down as efficiently so they fear postpartum hemorrhage.  

This, and possible poor fetal positioning, are the only minor concerns my MWs have about me. I have a history of neither so that's based solely on my status as a grand multipara. 

[womenswisdom]

Originally Posted by sharita 

However, cytotec is no longer used for induction, just abortion and portpartum. 

Cytotec is definitely still used for induction, unfortunately.

[mwherbs]

So a few years back there was a pretty large multi-center trial started trying to develop a removable vaginal inset for misoprostol, to help avoid hyperstim. When they set out the rules for patient selection for this trial , women with any previous uterine surgeries and women who had 4 or more births were to be excluded because they wanted to avoid any chance or associated chance of ruptures even if not due to using their product. I imagine that this may be the source of her concern given previous history of induction and prostaglandins. There are are some studies that show greatgrand multips at risk of rupture and others that dont, most of these having to do with malpresentation and prolonged labor, there maybe also an association with fibroids . The most devistating uterine rupture story I know of was a friend of a friend primip who had a late 2 nd trimester rupture presumably caused by a fibroid... She made several trips to the hospital before it was diagnosed, baby didnt survive and mom barely did, so these things are just unpredictable, we look at odds to try and give us some sense of control.