Uterine Rupture - the facts? - Mothering Forums

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Old 11-30-2007, 02:34 AM - Thread Starter
 
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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?
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Old 11-30-2007, 05:28 AM
 
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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.
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Old 11-30-2007, 07:29 PM
 
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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.
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Old 11-30-2007, 07:38 PM
 
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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).
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Old 11-30-2007, 10:35 PM
 
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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.

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Old 12-01-2007, 12:49 AM
 
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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

Mom of three spunktastic kiddos, supported by super-partner while dabbling in midwifery and organic farming. Biting off more than I can chew since '03.
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Old 12-01-2007, 01:03 AM
 
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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.

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Old 12-01-2007, 12:09 PM
 
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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.

Christine, mom to C(7.5) - E(5) - J(3) - B(10 mos)

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Old 12-03-2007, 12:45 AM
 
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Here is a good summary of a NEJM article on the risks of UR according to labor status and incision type.

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Old 12-05-2007, 03:21 AM
 
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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?

"In the depth of winter, I finally learned that within me there lay an invincible summer"
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Old 12-05-2007, 12:02 PM
 
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here's a good article about the risks in both:

http://childbirthconnection.com/article.asp?ck=10211

Christine, mom to C(7.5) - E(5) - J(3) - B(10 mos)

Doula, childbirth educator, Co-leader of ICAN of Atlanta

 

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Old 12-05-2007, 03:24 PM
 
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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...
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Old 12-05-2007, 04:09 PM
 
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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

Mom to James (ribboncesarean.gif 5/2006), Claire (vbac.gif 6/2008), furry kitties Calvin and Bob, and wife to Dennis. 

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Old 12-05-2007, 04:34 PM
 
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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.
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Old 12-05-2007, 04:40 PM
 
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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.

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Old 12-05-2007, 09:52 PM - Thread Starter
 
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Thank you all for your information & all the links. Very appreciated
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Old 12-05-2007, 10:18 PM
 
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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?

Midwifery Student and Mama to 2 daughters and 3 sons.     
ribboncesarean.gif vbac.gifhomebirth.jpg I have given birth a variety of ways and I am thankful for what each one has taught me.

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Old 12-06-2007, 03:45 AM
 
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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.
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Old 12-06-2007, 11:59 AM
 
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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!
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Old 12-06-2007, 01:33 PM
 
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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!

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Old 12-06-2007, 01:39 PM
 
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Thanks for the clarification majormajor.

I wonder why the failure rates go up after 42 weeks? Is it a flaw in women's bodies, or that care providers start to freak out?

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Old 12-06-2007, 01:49 PM
 
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Sorry but i didn't read all the posts so forgive me if this has already been said but when i looked into VBAC with my last pg what finally convinced me to do it is that there IS a risk for UR for women that DIDN'T have a previous c-section too, and we're all taking risks, I know we hate to think of it but we run the risk of dieing in a car accident, and the risk is WAY higher than a UR. I'm not trying to take the risk lightly but these are the things that were told to me when i was deciding for or against a VBAC and i had my VBAC, Such a wonderful experience
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Old 12-06-2007, 02:00 PM
 
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I wonder why the failure rates go up after 42 weeks? Is it a flaw in women's bodies, or that care providers start to freak out?
I think there are just more complications in general (for *all* births) after 42 weeks. Sometimes babies fail to engage, and that's why labor doesn't start earlier. Sometimes it's a positioning issue. Sometimes there may be just something goofy with the hormonal cascade so labor doesn't get initiated when the baby is "cooked"? These are the same reasons that still births go up after 42 weeks - fortunately only a *very* small percentage of babies/moms actually have these issues. (Figure that only 5-10% of all babies go past 42 weeks, and the vast majority of them come out just fine). Also babies that late may tend to be larger, so if there are any legitimate "tight fit" issues, they may manifest more often in post-dates babies.

There's probably a higher rate of inductions at this point (care providers freaking out), and that can lead to lower VBAC success rates too.

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Old 12-06-2007, 02:00 PM
 
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Thanks for the clarification majormajor.

I wonder why the failure rates go up after 42 weeks? Is it a flaw in women's bodies, or that care providers start to freak out?
speculating here, but i am guessing failure rates go up because as babies get older and the placentas age, they're less able to tolerate labor. and i think if you have heart-rate fluctuations that might have been ok with a non-VBAC labor, a dr is more likely to want to c/s just in case it's a sign of UR-related distress. that, and babies get bigger, and there's going to be at least some that are less likely to fit. esp. since it's a second baby, but a first delivery.

oh, and i agree with the PP about doing a non-chemical induction if at all possible. i think i'd even be ok with augmenting an underway labor with pit just a bit (increases UR risk a bit, but not as bad as a full-on induction) before i c/s'ed.
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Old 12-06-2007, 02:01 PM
 
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and everything kltroy said (we posted at the same time)
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Old 12-07-2007, 05:26 AM
 
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This actually came up when we were meeting with our doula today... and her inference on the issues with "postdates" babies was the same as mine: Ok, there are more issues (not just for VBAC, but in general). But, what's the causality? The assumption is that baby staying in longer is bad for baby... but it seems just as likely, if not moreso, that babies who HAVE a problem of some kind are more likely to go post-dates. Granted, it may be that the problem is easier to address outside the womb, but if they're tangled in their cord, or can't get a good position, or whatever, the birth is probably not going to go as well.

But, on the other hand, there are babies who go to 42, 43 weeks, and then are born with no issues at all, and don't look at all "overcooked." Some women ALWAYS go that long with each pregnancy. So... is it necessarily a good idea to get all freaked out about postdates babies when for some, it's totally normal, and for others, it may be that they're staying in because of a problem, not that they're going to have problems from staying in too long?
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Old 12-07-2007, 08:33 PM
 
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This actually came up when we were meeting with our doula today... and her inference on the issues with "postdates" babies was the same as mine: Ok, there are more issues (not just for VBAC, but in general). But, what's the causality? The assumption is that baby staying in longer is bad for baby... but it seems just as likely, if not moreso, that babies who HAVE a problem of some kind are more likely to go post-dates. Granted, it may be that the problem is easier to address outside the womb, but if they're tangled in their cord, or can't get a good position, or whatever, the birth is probably not going to go as well.
This has been my gut feeling about it for a while.

Quote:
But, on the other hand, there are babies who go to 42, 43 weeks, and then are born with no issues at all, and don't look at all "overcooked." Some women ALWAYS go that long with each pregnancy. So... is it necessarily a good idea to get all freaked out about postdates babies when for some, it's totally normal, and for others, it may be that they're staying in because of a problem, not that they're going to have problems from staying in too long?
At the very least, I wish they'd look at family history - on both sides. I had a 38w,5d pregnancy with ds1. His dad's (my ex) mom didn't have long gestations. Neither did mine, as far as we know (her first was an emergency section and my sister and I were scheduled repeats).

DH's kids: DD went to 39w,2d, and then I let myself be bullied into a scheduled repeat because she was breech (and apparently if I waited for labour to start, then went to the hospital, we'd both keel over and die at the first contraction...bitter - who, me??). She was too early - I have no doubts that she was at least a full week from being ready to be born, and I'd guess more like two. I caved on the repeat with ds2, as well...bu I went into labour the night before...at 41w, 4d. The section was done at 41w, 5d, and I was barely starting to dilate (under 1cm). I suspect I'd have gone to 42 weeks or very close with him. True labour started at about 43 weeks with Aaron (bad example, perhaps, as he was stillborn...but I laboured a long time before that, and there's the multiple section part of the equation, too). DH's mom carried all four of her boys to over 42 weeks, with no problems at all. They were all over 9lbs. and they were all born vaginally.

I really think dh's kids are just genetically inclined to "cook" longer.

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