Uterine rupture is SO not worth it for a VBAC
It’s an unfortunate reality that a lot of people believe:
1. If you have a cesarean, your baby will be born healthy.
2. For a woman with a prior cesarean, you are not at risk of uterine rupture until labor begins.
The reality is…
1. There are no guarantees regardless of how your baby is born – VBAC or repeat cesarean.
2. What puts you at an increased risk of uterine rupture is getting pregnant after having a cesarean.
You can rupture at any time during your pregnancy. So, at what point do you want to be admitted to the hospital? 38 weeks? 35 weeks? 30 weeks? 12 weeks? Whether you are planning a HBAC, hospital VBAC, or repeat cesarean, complications can arise at any point during your pregnancy, when you are not in the hospital. For example, your placenta can separate from the uterine wall (placental abruption) severing your baby’s oxygen supply. The risk of this occurring is about 0.4% – 1.3%. This is a very dire situation and planning a hospital birth, or a repeat cesarean, does not guarantee you a better outcome if this occurs while you are sitting in front of the TV in the comfort of your home. There is this perception that if you schedule your cesarean, everything will be okay. But that is not the truth.
This is from a blog I recently commented on:
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Uterine rupture is SO not worth it for a VBAC. Not at all… What’s most important is getting the baby out safely. Period.
Your questions and answers are making me want to do lots of searches to learn more about you. 
R, Having a repeat CS does not eliminate the risk of uterine rupture nor does it guarantee a healthy baby. Any OB who tells you so is either lying or misinformed. Uterine rupture can, and does, occur before labor. The thing that puts you at an increased risk of uterine rupture is getting pregnant after having a cesarean.
If a woman wants a repeat cesarean, that is her decision, but I hope her OB is not misinforming her by stating she has a 5% UR rate after 2 CS… because there are no large studies supporting that number. From http://vbacfacts.com/vbac/#URVC : “While the rates of rupture among women who do not experience labor and opt for a ERCS [elective repeat cesarean section] are lower, they expose themselves to the additional risks associated with surgery. This is supported by Mozerkewich 2000 (VBAC 0.4% vs. ERCS 0.2%), Korst 1999 (VBAC 0.53% vs ERCS 0.28%), and Lyndon-Rochelle 2001 (VBAC 0.6% vs ERCS 0.16%).”
Please go here to view the risks of surgery and how the risks increase with each subsequent surgery and here to view how the risk of uterine rupture goes down with each VBAC.
My objective is simply to provide women with accurate information backed up by medical studies.
All my best in however you decide to birth your children,
If you are curious to read the post R initially replied to, read on….
Hi! I just wanted to share that if they gave you the 5% rupture rate based on the fact that you have had two cesareans… well, that’s just way higher than the latest study looking at rupture rates after 2 or more CS. That’s the Landon 2006 study and they found a 0.9% rupture rate among women who two prior CS… and I’m sure some of those women where induced/augmented, so the rupture rate of women with a spontaneous, natural progressing labor would be lower. Here’s a link to the study.
If you are interested in VBA2Cing, you can read about how to find a supportive OB or midwife and the questions to ask them.
It’s also important to look at the VBAC and cesarean rates at the hospital you are going to because it’s not enough that your hospital “allows” VBAC.
Unless, of course, you are interested in a homebirth VBAC which some insurance companies do cover.
I had a great VBAC at home. Recovery was a breeze. Pain from childbirth was nothing like recovering from a cesarean. It was totally manageable. To be drug-free and fully aware and present when my baby was born was priceless. To have him drug-free and fully aware was amazing. To eat and drink immediately after labor … was so satisfying after all that hard work!
You can read my birth story.
Best of luck with your desicion!
Jen
Great website! Thanks for fighting the good fight for moms and their uterine integrity! It really is amazing to me doctors act as though a ‘controlled uterine rupture’ (aka a c-section) doesn’t have serious risks itself!
My HBAC went fine! Remember how the Navy Hospital fought me every step of the way? Well, it isn’t over yet! This week at my son’s 2 week appt the pediatrician lectured me for 10 minutes about how irreponsible and dangerous my course of action was. He even said the REAL risk of uterine rupture was 10% or even 20% and that ACOG was trying to change the stats to reflect this. (Really? Once again when I asked which studies showed this I got now answer.) I just think it is funny that even though I had a great birth with NO problems they are still after me! (I wouldn’t trade it for the world, though!)
Tonya, Congratulations! Isn’t it amazing!? I’m so sorry your pediatrician is giving you a hard time. Lies, lies, and lies. What a shame. Best, Jen
I am 22 weeks pregnant and haven’t been able to find a care provider willing to take me for a VBA4C. My OBGYN even told me that the risk of rupture after the first section is 10% and that 25% of those end up with neurological or learning disorders (I thought that was true of the general populace.) She said there are NO studies on VBAMC. I feel lied to and cheated out of a normal birth (I now believe that my for c-sections were unnecessary) and desire to have the chance that so many other have, to deliver a baby naturally and without all the risks of a cesarean. It does seem to be true, the risks for VBAMC does not significantly increase, yet here in Houston the hospitals and midwives are not willing to ‘risk’ it. So I am considering an unattended birth, not out of a desire to have my first vaginal delivery alone, but because I feel I have no other options. I have an apt with yet another midwife this weekend and a doctor in a week but I really don’t have high hopes for either one as I have done this about 20 times already, all with providers that are KNOWN for doing VBACs. Any suggestions on alternatives to an unattended birth or how to otherwise get the opportunity to have the kind of birth I want?
Sarah, I have to say upfront, I am not a doctor or a midwife, so I can not give you medical advice. What I can do is point you to information. To my knowledge there are not any large studies looking at VBA4C. It is the realm of the unknown. There are a bunch of very small studies where some of the participants were a VBA3C or VBA4C, please click here for an excellent summary. I personally would not have an unattended birth. I had a post-partum hemorrhage (PPH) at my HBAC and don’t know what would have happened if my midwife did not have the ability to quickly diagnose the PPH, access to Methargine and Pitocin (drugs used to make the uterus contract and stop bleeding), and the ability to quickly administer it. Sometimes crap just happens. Have you read Finding a VBAC Supportive OB or Midwife? An OB might be willing to give you a chance if you agree to external continuous fetal monitoring and to go to the hospital shortly after labor begins. But, you need to find an OB who is truly supportive of VBA2C and negotiate. Realize that s/he is really, really going out on a limb for you. Build a rapport and trust with this OB. They are putting their professional career at risk if anything goes wrong. It’s also important for you to know that if you do need an emergency cesarean after a trial of labor, the (many?) adhensions in your abdominal cavity could make the surgery longer and more complicated which could put your baby at risk. I wish I had more encouraging news for you. I’m sorry. Best, Jen
Sarah, I am very interested to hear how your story turned out. Please let us know!
Kelli
kellihewitt13@yahoo.com
Hi guys i was wondering if anyone know r knew of a doctor/midwife willing to consider a VBA2c. If anyone could help please do. ineasha2005@yahoo.com
your uterus will rupture in a hospital birth becuase pitocin, cytotec, cervidal is known to rupture uterus, and since women were never meant to birth in a hospital why risk the chance of rupturing their uterus when you can simply give them a c-section. So VBAC are way safer at home.
#2 is very important for people to understand. Uterine rupture can happen BEFORE you even go into labor, and many doctors will not even tell you this. I can’t stress enough the importance of having done your homework before going into a VBAC.
Personally I had a smooth 2nd pregnancy, until I went into labor 4 days before my scheduled c-section (first baby was emergency c) and my uterus did begin to rupture. I do have to say that I got pregnant after only 8 months healing from the first c-section and that that probably contributed to the complication. Both mommy and baby are safe