anyone have info on rates of UR for births *after* a successful VBAC?

[KKmama]

I really am not sure where to look for this (and FWIW, I'm not at all concerned about it, just mildly annoyed)...

Anyone have any info/stats/etc about the rates of UR in subsequent births after a successful VBAC?

I had a VBAC with kid #2, and my doula wanted me to check on whether I will be required to have continuous monitoring again during labor, since I have a "proven pelvis/proven scar." Of course, I will (and I'm sure it's for liability reasons, not due to real risk)... I'm not going to fight it, because they have telemetry units and concessions have been made (by them) in other areas. But of course I was wondering how much real risk is behind the requirement (I assume there's very little risk of UR in subsequent births).

[TanyaS]

This question was recently posed on the ICAN list. There aren't enough statistics for UR on subsequent VBACs. However, the most recent rupture rates were posted by the president of ICAN. They are:

The most recent NEJM study from December 2004 found rates as:
0.4% for spontaneous onset of labor, no augmentation
0.9% for augmented labors
1.1% (or maybe 1.2%) for induced labors.
The average UR rate was .7 when the lumped them all together.
Its not a big difference from prior studies which found 0.5%

If you notice the new rates, OBs double them by attempting induction or augmentation.

My OB that I had for my VBAC said he would follow ACOG guidelines for EFM. I was monitored every 30 minutes for about 5-10 minutes until transition and pushing at which point it was continuous. Continuous EFM during all of labor are not ACOG's guidelines. Telemetry does allow you freedom of movement, but it still is unneccesary monitoring, imo. If the OB is so cautious as to require continuous EFM, then how cautious will he be with the baby's heart rate and how quickly will he jump to a c/section? Just something to consider!

[KKmama]

I didn't realize that their practice was different from the ACOG recommendation. I think I will check into that and bring it up at my next appt.

I will say... I've already had one successful VBAC with this OB practice (all women by the way--aren't most OB/GYNs female these days, anyway?), and I'm not concerned that they are "looking" for any reason to do another C. My labor with Z was long (40 hrs), I was "late" (41 wks 5 days), and I was given 2+ hours to push. I'm kind of assuming that the continuous fetal monitoring may have to do with their liability insurance... if it comes down to that, I'm willing to do it--not a big deal to me.