Myth: Two numbers less than 1% are similar
I have often heard, “If two numbers are less than 1%, they are similar.” Typically
this is expressed while comparing the risks of rupture in an unscarred versus scarred uterus. But is this true? How different can two numbers less than 1% be?
Two numbers less than 1% are no more similar than two numbers greater than 1%
Just because two numbers are less than 1%, that doesn’t make them any more similar than two numbers greater than 1%. A 2% risk of something happening is very different than an 89% risk. While they are both greater than 1%, they represent drastically different levels of risk.
2% = 1 in 50 risk
89% = 1 in 1.12 risk
89% represents a 44 times greater risk than 2%.
What about numbers less than 1%?
It might seem rational that since numbers less than 1% are so small, that there wouldn’t be as much of a difference between them. But numbers less than 1% work in the same way as those greater than 1%. Let’s run a few and measure the difference.
1 in 100 represents 1%.
1 in 1,000, is the same as 0.1%, and is 10 times smaller than 1%.
1 in 10,000, is the same as 0.01%, and is 100 times smaller than 1%.
1 in 100,000, is the same as 0.001%, and is 1,000 times smaller than 1%.
1 in 1,000,000, is the same as 0.0001%, and is 10,000 times smaller than 1%.
Comparing small risks
According to Zwart* (2009), the risk of uterine rupture in:
– an unscarred mom is 1 in 14,286 (0.007% or 0.7 in 10,000) and
– a scarred mom is 1 in 156 (0.64% or 64 in 10,000).
(Both statistics include non-induced/augmented, induced, and augmented labors.) Even though both numbers are less than zero, they represent very different levels of risk. In fact, the risk of rupture in an unscarred mom is 91 times smaller than a scarred mom. It’s not that the risk of rupture is excessively high in a scarred mom, but that it is so very, very, very low in an unscarred mom.
Using the language from Kim James’ handout Understanding Obstetrical Risk, the risk of rupture in an unscarred mom would be described as “very rare” whereas the risk of rupture in a scarred mom would be described as “uncommon.”
Take away messages
Just because two numbers are less than 1% does not mean that they are similar. Numbers below 1% represent just as much of a range as numbers greater than 1%.
While the risk of scar rupture is very different than the risk of unscarred rupture, it is similar to other serious obstetrical emergencies such as placental abruption, cord prolapse, and postpartum hemorrhage.
Zwart, J. J., Richters, J. M., Ory, F., de Vries, J., Bloemenkamp, K., & van Roosmalen, J. (2009, July). Uterine rupture in the Netherlands: a nationwide population-based cohort study. BJOG: An International Journal of Obstetrics and Gynaecology, 116(8), pp. 1069-1080. Retrieved January 15, 2012, from http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2009.02136.x/full
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As an internationally recognized consumer advocate and Founder of VBAC Facts®, Jen helps perinatal professionals, and cesarean parents, achieve clarity on vaginal birth after cesarean (VBAC) through her educational courses for parents, online membership for professionals, continuing education trainings, and consulting services. She speaks at conferences across the US, presents Grand Rounds at hospitals, advises on midwifery laws and rules that limit VBAC access, educates legislators and policy makers, and serves as an expert witness and consultant in legal proceedings. She envisions a time when every pregnant person seeking VBAC has access to unbiased information, respectful providers, and community support, so they can plan the birth of their choosing in the setting they desire.