or Connect
Mothering › Mothering Forums › Pregnancy and Birth › Birth and Beyond › VBAC › Uterine Rupture - the facts?
New Posts  All Forums:Forum Nav:

Uterine Rupture - the facts?

post #1 of 27
Thread Starter 
After a unnecessary c/sec four yrs ago, I'm planning to VBAC our next kidlet. The one fear (at this time) is uterine rupture. Where can I find the real facts about this? Some things I read say it's not an issue "yes, it happens, but not to extent docs flaunt it..." then I read "oh you better believe it can happen":

Can anyone suggest a true answer?
post #2 of 27
Actual statistics on uterine rupture rates vary from study to study, but the generally accepted numbers thrown around are 1 in 200 VBAC attempts for actual rupture with 1 in 2000 VBAC attempts resulting in UR where baby does not survive.

What that means is there is about a 0.5% chance you'll rupture. If you *do* rupture, there's about a 10% chance that baby won't survive. Not sure what the stats are for brain damage or other long term damage as a direct result of UR.

There are things you can do to decrease your risk of UR including having pg that are spaced at least 18-24 months between deliveries and not using any drugs at all to induce or augment labor.

When reading studies, you want to be sure you know if they are talking about true ruptures or if they included 'windows' noted in the uterus that weren't true ruptures.

Does UR happen? Sure it does.

Is it enough reason to NOT VBAC? Only the individual mother in question can decide which set of risks she feels most comfortable with. ERCS isn't a risk free choice by any means, so you have to weigh the risks of each choice and go from there.
post #3 of 27
ERCS isn't a guarantee that you won't have a ur either. The chances are smaller, but it's not like their zero. I think it's also important to keep in mind when reading studies is whether their refering to something in terms of relative risk which can inflate the risk.

IMO ur is certainly a risk, but in life I think it's pretty much impossible to avoid risk. And yes, I do agree with the others that you've heard from that say that it's really not as big of a deal as the powers that be make it out to be. wifeandmom hit the nail on the head with her explanation.
post #4 of 27
I had one sans surgery of any kind to the uterus (the reason for my first c section besides a frank breech with prolapsed cord).

My first 3 births before my first section were natural births and the one after the first c\s was another "preventative" c\s due to risk of rerupture fears and high risk pg.

Sheal

NOTE: I am a freak of nature though, I'm one of those rare few and my rupture, I believe, was due to reactive bicorneated uterus (where both chambers work) and she was in the smaller reactive chamber that couldn't handle the size of her during contrax, causing the rupture.

It is a rare occurance and every pg, every woman has a very SMALL risk of rupture regardless of prior surgery or not. I was in labor for 1.5 hrs with my last despite fears because the doc couldn't find my medical files and sat on his @ss twiddling his thumbs waiting for "lost" charts. I didn't rupture the second time and I was in full transitional labor (I'm quick) with full dilation and effacement. This is with a prior rupture less than 2 yrs earlier (approx 1 yr 9 months later).
post #5 of 27
Quote:
Originally Posted by AJohns View Post
Some things I read say it's not an issue "yes, it happens, but not to extent docs flaunt it..." then I read "oh you better believe it can happen":
I'm honestly not sure what you are looking for. Both of those statements are true. It is not as likely as most OBs would have you believe. But it does happen and the effects can be deadly for mom and baby. This is the dilemma that having a cesarean puts you in with subsequent pregancies.
post #6 of 27
This is a website that compares single layer closures and double layer closures for UR (these are the types of stitching done to close up your first incision and you can find out what kind you have by talking to your surgeon or getting your operative report)
http://www.collegeofmidwives.org/new...r_study01b.htm

This is a website that has all kinds of information on c/s, vbac, and UR. It will also show you how to get in touch with members of ICAN locally, and I strongly recommend you do that to get more information, share stories and healing, and build some positive birthing community.
www.ican-online.org

UR is definitely a real thing that does happen. That being said, I have never personally met a person who had one as a result of vbacing. PPs are very right in saying that you have a risk of rupture even without previous surgery and even if you plan to ERCS. The accepted margin of risk for UR is as the pp stated .05%-.08% depending upon who you talk to. Pitocin is probably the number one cause of rupture in vbacing women so do NOT allow it at your next birth and if your care provider suggest that it might get used, switch providers immedeatly. Statistics for UR are only based upon hospital TOL and have not been accurately recorded for homebirth, though the unofficial concensus among the homebirthing midwives that I know is a UR rate of
.0%-.02%.
Good books on the subject include Pushed, Open Season, Silent Knife (a personal fave), Thinking Woman's Guide..., and Ina May's Guide to Childbirth Research, research, research. Talk to as many people as you can in your life and online about these subjects. Knowlege really does equal power in this scenario. (Like it doesn't in all the rest ) Hope this helps
post #7 of 27
Quote:
Originally Posted by egoldber View Post
I'm honestly not sure what you are looking for. Both of those statements are true. It is not as likely as most OBs would have you believe. But it does happen and the effects can be deadly for mom and baby. This is the dilemma that having a cesarean puts you in with subsequent pregancies.
This is almost exactly what I was going to post.
post #8 of 27
Quote:
Originally Posted by kathan12904 View Post
Pitocin is probably the number one cause of rupture in vbacing women so do NOT allow it at your next birth and if your care provider suggest that it might get used, switch providers immedeatly.
I really think this is up to each person to decide. Pitocin does increase the risk of UR but it is still low. Depending on the reason pit is being used, some women would choose that over ERCS.
post #9 of 27
Here is a good summary of a NEJM article on the risks of UR according to labor status and incision type.
post #10 of 27
I am very interested in all of this!!!

But here's my question- how can I find out how uterine rupture rates compare with other risks associated with birth?? Like, for example, developing a complication from having a c-section? Statistically, is it safer to try the VBAC or go with the c-section? Does that make sense?
post #11 of 27
here's a good article about the risks in both:

http://childbirthconnection.com/article.asp?ck=10211
post #12 of 27
Quote:
Originally Posted by sparklett View Post
I am very interested in all of this!!!

But here's my question- how can I find out how uterine rupture rates compare with other risks associated with birth?? Like, for example, developing a complication from having a c-section? Statistically, is it safer to try the VBAC or go with the c-section? Does that make sense?
i've read quite a few papers on VBAC vs. ERCS. my conclusion, and the data that i'm basing my decision on, is that VBAC carries a higher chance of death and permanent injury for the baby, but is safer for mom (mom has 2 to 3 times the chance of dying from c/s, though overall is still 10 times less likely to die than baby).
the risk of the baby dying or being permanently injured due to VBAC is approx. 1 per 1,000. assuming all of the best circumstances (good incision, 24+ mos between births, etc). if it's a first vaginal delivery, that means the baby has a risk of about 2 in 1,000 of dying, maybe 3. it's really hard to add in the severe injury risk (brain damage, etc, because i don't often see it quantified). the risk of the baby dying due to c/s is lower, probably about 0.5 in 1,000.

all this said, i'm planning to VBAC. i'm doing it at a great hospital that can have the baby out in 10 minutes or less, no matter what time of day. if i reach 40 or 41 weeks without labor or imminent labor, i'll c/s.

anyway, it's hard. like i said, these are the numbers i trust. i've seen a whole range, though...
post #13 of 27
Quote:
Originally Posted by sparklett View Post
But here's my question- how can I find out how uterine rupture rates compare with other risks associated with birth?? Like, for example, developing a complication from having a c-section? Statistically, is it safer to try the VBAC or go with the c-section? Does that make sense?
Sure... the answer, from what I understand is that statistically, it's safer for the BABY to go with the c-section (I believe there's about a 0.01% incidence of death to the baby with c/s). It's much easier on MOM to go with the VBAC (much easier recovery, labor and vaginal birth are good for the baby etc - lots of good reasons to do this one). And because the risks to the baby associated with VBAC are so small (0.5% incidence of UR and probably about 0.05% baby death), it's recommended.

Still, if you look at the stats THAT way, you could say "VBAC has a 5-fold increased risk of death to your baby compared to c-section!!!" Which is technically true, but since they're BOTH so small, go with what is better for YOU, IMHO. I'm planning my VBAC for June '08
post #14 of 27
Quote:
Originally Posted by sparklett View Post
I am very interested in all of this!!!

But here's my question- how can I find out how uterine rupture rates compare with other risks associated with birth?? Like, for example, developing a complication from having a c-section? Statistically, is it safer to try the VBAC or go with the c-section? Does that make sense?
IMO it IS most definitely safer to VBAC. There are many more risks to surgery then there is to vaginal births.
post #15 of 27
As for uterine ruptures, any woman in labor can have a uterine rupture, not just a woman with a prior surgery on her uterus.

Therefore, all women in labor are at risk for a uterine rupture. Whether or not a prior caesarean section predisposes a woman to a rupture is a statistical discussion and depends on how well the uterus healed, how well the surgeon sutured the incision, where in the uterus the incision was made and many other factors.


Suggest that you get your surgical records, get out a good Taber's and go over it with some one else who is savvy about reading such things. Good luck.
post #16 of 27
Thread Starter 
Thank you all for your information & all the links. Very appreciated
post #17 of 27
Quote:
Originally Posted by majormajor View Post

all this said, i'm planning to VBAC. i'm doing it at a great hospital that can have the baby out in 10 minutes or less, no matter what time of day. if i reach 40 or 41 weeks without labor or imminent labor, i'll c/s.
Sincerely curious as to why? Does UR go up further postdates?
post #18 of 27
OP - Some of the studies on ICAN's "Top 12 Studies from 2007" may be of interest to you as well.

milkydoula - From a study mentioned on the link above (Coassolo, et al., Obstet Gynecol. 2006 Jan;107(1):205)

Quote:
The risk of uterine rupture (1.1 percent compared with 1.0 percent) or overall morbidity (2.7 percent compared with 2.1 percent) was not significantly increased in the women attempting VBAC beyond the EDD. Women beyond 40 weeks of gestation can safely attempt VBAC, although the risk of VBAC failure is increased.
I'm sure majormajor can clarify her line of reasoning, though.
post #19 of 27
Quote:
Originally Posted by milkydoula View Post
Sincerely curious as to why? Does UR go up further postdates?
UR doesn't go up, but the chance of a successful VBAC drops. but for me, it's entirely based on the fact that DD was born at 41 w 2 days looking absolutely post mature. i just have a suspicion that my body has its babies fully cooked by 40 weeks, and i don't want to risk going past 41.

sorry, i should have clarified that from the beginning. nothing to do with UR!
post #20 of 27
Quote:
Originally Posted by majormajor View Post
UR doesn't go up, but the chance of a successful VBAC drops. but for me, it's entirely based on the fact that DD was born at 41 w 2 days looking absolutely post mature. i just have a suspicion that my body has its babies fully cooked by 40 weeks, and i don't want to risk going past 41.

sorry, i should have clarified that from the beginning. nothing to do with UR!
This is true - though from what I've read the success rate doesn't really start dropping until after 42 weeks. Everyone has their own threshold of what they're comfortable with. For *me*, if I go much past 41 weeks I will consider an induction (in this order: herbal methods, sweep membranes, foley, and pit as an absolute last resort) before I consider a repeat c/s. A crappy vaginal birth still beats the heck out of major abdominal surgery, IMHO!
New Posts  All Forums:Forum Nav:
  Return Home
  Back to Forum: VBAC
Mothering › Mothering Forums › Pregnancy and Birth › Birth and Beyond › VBAC › Uterine Rupture - the facts?