Older Posts

Myth: 50% of uterine ruptures occur before labor

Side profile of a pregnant woman

Becky recently ask this question on the VBAC Facts Community:”I read somewhere that the risk of uterine rupture is actually higher during pregnancy than during birth. Does anyone have a source for this?” […]

False comparison: Fatal car accidents (or other non-birth risks) and VBAC

technology

While these statements are very comforting, as birth myths tend to be, they are false comparisons. We can accurately and fairly compare the risks of a TOLAC to the risks of a repeat cesarean or the risks of a first time time. However, it is a misleading to compare the risks of birth to non-birth events. […]

Can you feel a uterine rupture with an epidural?

mardigrasmask

Some care providers discourage epidurals in VBAC moms fearing that it will mask the symptoms of uterine rupture (namely abdominal pain) and delay diagnosis resulting in a poor outcome for baby and to a lesser extent, mom  Other care providers suggest or even require VBAC moms to have an epidural so that a cesarean can quickly take place if needed.  Which philosophy does the evidence support?

Review of 14 VBAC studies

I recently came across a study entitled “The Role of Epidural Anesthesia in Trial of Labor” (Johnson, 1990) that reviewed 14 VBAC studies.  Johnson found […]

Myth: VBACs should never be induced

IVdrip

Spontaneous labor is always preferable to induced or augmented labor but there are medical conditions that can necessitate the immediate birth of a baby. It’s nice for those women for whom vaginal birth is still an option to have a choice: gentle induction/ augmentation or repeat cesarean. Of course, informed consent reviewing the risks and benefits of their options is essential. Some women might be more comfortable scheduling a cesarean whereas others might want to give a gentle Pitocin and/or Foley catheter induction a go. […]

The best compilation of VBAC/ERCS research to date

“There is a major misperception that TOLAC [trial of labor after cesarean] is extremely risky” – Mona Lydon-Rochelle MD, March 2010. “In terms of VBAC, “your risk is really, really quite low” – George Macones MD, March 2010. Both Drs. Macones and Lyndon-Rochelle are obstetricians and researchers who made these statements at the 2010 NIH [National Institutes of Health] VBAC Conference. Now you may think, “Wait a sec. Everything I’ve heard from my family, friends, and medical provider is how risky VBAC is and how cesareans are the conservative, prudent, and safest choice.” Why the discrepancy between the statements of these two doctor researchers and the conventional wisdom prevalent in America? […]

Confusing fact: Only 6% of uterine ruptures are catastrophic

questionmarkwoman

How many times have you heard “Only 6% of uterine ruptures are catastrophic” or “Uterine rupture not only happens less that one percent of the time, but the vast majority of ruptures are non-catastrophic?” But what does that mean? Does that mean only 6% of uterine ruptures are “complete” ruptures? Result in maternal death? Infant death? Serious injury to mom or baby? This article will explain to you the difference between uterine rupture and uterine dehiscence as well as explain the source and meaning of the 6% statistic. […]

Myth: Induced unscarred mom as likely as VBAC mom to rupture

Fact or Myth

Update 1/20/12 – Someone who believed this birth myth to be true, told me that the source of this information was an OB from St. Louis who presented at the 2011 ICAN conference. I contacted ICAN and they said that the person must be referring to Dr. George Macones. Yet, no one on the ICAN Board, who were seated at the front table during his presentation, remembers him saying that induced, unscarred women have the same risk of uterine rupture as a VBAC mom. And I would think that if he gave a stat like, everyone would have remembered because […]

Birth intervals & uterine rupture aka how long to wait to VBAC

Time management

Suzanne recently left this comment in response to the article, I’m pregnant and want a VBAC, what do I do?

Hi. I’m new to your site and just trying to get some more info on VBAC. My daughter was a normal vaginal delivery. My second pregnancy(a surrogate pregnancy) was also a normal vaginal delivery. My third (also a surrogate pregnancy) was twins. I had planned to attempt a vaginal delivery with the twins with the support of my OB as long as Baby A was head down. Unfortunately she was breech and I ended up with a c-section at 36 […]

Lightning strikes, shark bites & uterine rupture

Lightning - Tucson, AZ

When someone understates the risk of UR, I think it’s just as important the clarify as it is when someone overstates the risk. How else are women to make an informed decision? Just as it’s plain wrong for an OB to tell a woman with one prior low transverse cesarean that she has a 20% risk of rupture, it’s equally wrong when VBAC advocates say the risk is virtually non-existent.

Over the years, I have heard the statement: “You are more likely to be struck by lightning or bitten by a shark than experience uterine rupture!”

Today I’m going to […]

If VBAC is reasonable, why does my OB say it is dangerous?

This is a question that I’ve heard a lot.

Here is the three second answer: VBACs got a bad rap in the 1990s before we understood the increased risk of rupture during an induced VBAC labor, especially with Cytotec.  Even if your OB is supportive, s/he may be under pressure from hospital administrators, or other OBs in their practice, who feel differently.  Finally, your OB might have experienced a recent lawsuit, uterine rupture, or other bad outcome that influences the way they counsel you.

In the 90s, babies and moms were unnecessarily injured and died when VBAC labors were induced […]

Predicting uterine rupture by uterine thickness via sonogram

A couple weeks ago Virginia from Switzerland left this comment:

I am planning to have a vbac at a hospital in Geneva, Switzerland. In general, they are very supportive of vbacs here.

It is common practice here to measure the uterine scar at 37 weeks using a sonogram. Apparently, if the scar tissue is 3.5mm or higher – it is very unlikely for a rupture. Mine happens to be 2.95mm. The hospital staff tells me I have a 3 – 4% chance of a rupture versus a standard .05% chance of rupture. They warned me that I will be monitored […]

VBAC vs. Repeat Cesarean by the American Academy of Family Physicians

This is a great piece for deciding between VBAC and repeat cesarean.  Those who wish to VBAC, but have husbands, family, and/or friends who don’t understand why, might find this document very useful.  I have found that people who are anti-VBAC really seem impressed by what doctors and medical organizations have to say, so I’m thinking they will find this document compelling.  Plus, VBAC has this reputation of being “risky” and repeat cesareans are thought of as the “conservative approach,” and this document challenges both lines of thinking.  Why not write a sweet little note like, “I know you are […]

Uterine rupture risk drops significantly after first VBAC

elevator down

As we know, the risks of cesareans increase with each surgery which is why family size should be considered when evaluating your post-cesarean birth options. Couple that fact with the results of Mercer (2008) which found that successful VBAC also provides a level of protection to future deliveries.

Mercer found that not only do the risks of uterine rupture, uterine dehiscence and other peripartum complications decrease after the first VBAC, but “VBAC success increased with increasing number of prior VBACs” to rates over 90% for women with two or more prior VBACs.  They also found that while two or more […]