Well, I am the aforementioned friend of RachelGS and also the mama mentioned by Heavenly. I had a uterine rupture in April and lost my baby. Since then, I have read and re-read in great detail all the info that I can find available related to uterine rupture in an attempt to process and understand what happened to me.
If you read the NEJM December 2004 study, the risk of rupture with NEITHER augmentation NOR induction is .4% (or about 1 in 200). The rupture rate is actually higher for women who are induced or augmented. Note that rupture rate does NOT include dehiscences in this study, just ruptures. The study puts the risk of perinatal death from rupture at 4 in 10,000 (or 1 in 2000) for those choosing TOL and at 1.4 per 10,000 for those choosing ERCS. Both are low. Rates of maternal death are slightly higher in the ERCS group, but overall maternal complication rates were actually highest in the group that had a failed VBAC.
One thing I have learned since my experience and that is not really talked about is what happens to the babies who do NOT die from UR. Most go on to live normal lives. But many do not. Many have issues ranging from minor developmental delays to severe, severe CP. I belong to a Yahoo Group for women who have had a uterine rupture and many of the women with UR survivor children have a life long battle ahead of them in raising their children. I have learned that sometimes there are things worse than having your baby die, as hard as that is to believe. One woman on my group recently tried to kill herself.
Now the thing to think about is what does all this mean. I lost my child in a UR. But there have been many (too many) mamas on MDC lately who have lost their newborn babies for completely unrelated reasons. Birth accidents happen. Sometimes babies die.
I will say that while I remain convinced of the overall safety of attempting VBAC (under the right circumstances), I personally now have a hard time urging other women to have one. I know that I wish every day and will for the rest of my life that I had endured 100 unnecessary cesareans to have my Leah back in my arms. I DO urge women that I can influence to avoid primary cesareans if at all possible.
One thing that irritates me is when I read things like "if you aren't induced, aren't on your back, you won't rupture". Well, thats simply not true. Even if you do all the "right" things, you can have a UR. While aumentation and induction and other things can increase the risks of UR, you ultimately can't know who will rupture and who will not. Of course ERCS is not without its risks, but a scarred uterus is a scarred uterus and as such is more likely to rupture than an unscarred one.
Here is a link to some criteria recently developed in Britain which tries to predict who might have an emergency C-section during a VBAC attempt. Interestingly, I met 3 of the 6 criteria (older, shorter, no history of prior vaginal birth). http://www.medpagetoday.com/OBGYN/Pregnancy/tb/1734
Honestly, I'm not sure what the point of this post is. I just think its important for women to fully understand their choices. I know that if I had really believed "it could happen to me", I would never have attempted a VBAC. There are just no guarantees in anything and you have to be able to live with the result of your choices.