Myth: 50% of uterine ruptures occur before labor
Becky recently ask this question:
I read somewhere that the risk of uterine rupture is actually higher during pregnancy than during birth. Does anyone have a source for this?
Becky,
I had heard the same thing many times. However, no one who shared this stat with me could ever cite a study substantiating it. I looked and looked on and off for years and never found it.
Instead, I found “Uterine rupture in the Netherlands: a nationwide population-based cohort study” (Zwart, 2009), “the largest prospective report of uterine rupture in women without a previous cesarean in a Western country.” Zwart differentiated between uterine rupture and dehiscence and included 97% of births in The Netherlands between August 1, 2004 and August 1, 2006. All told, Zwart studied 358,874 total deliveries, 25,989 of which were TOLACs.
I have referenced Zwart before when comparing scarred vs. unscarred rupture rates and scarred vs. induced, unscarred rupture rates. Zwart also included data on pre-labor rupture which I will share with you as well.
Scar rupture before labor
Zwart reported that 9% (1 in 11) of scar ruptures (women with prior cesareans) happened before the onset of labor. When we take 9% of the overall scar rupture rate of 0.64% (1 in 156)*, we get a 0.0576% (1 in 1736) risk of a scar rupture before labor.
Unscarred rupture before labor
Zwart (2009) found 16% (1 in 6.25) of ruptures in women without prior cesareans (unscarred ruptures) occurred before labor and an overall unscarred rupture rate of 0.007% (1 in 14,286)*. When we multiply these two numbers, we get a 0.00112% (1 in 89,286) risk of uterine rupture in an unscarred uteri before labor.
Here is a table comparing the numbers:
| Overall UR Rate | % of URs that Occur Pre-Labor | Pre-Labor UR Rate | |
| Scarred Uteri | 0.64% | 9% | 0.0576% |
| Unscarred Uteri | 0.007% | 16% | 0.00112% |
The war of the studies
Remember, all these stats are based on one study. Other studies might find different rates. However, I think Zwart would have the most accurate rates to date as it is “the largest prospective report of uterine rupture in women without a previous cesarean in a Western country.” This is an important factor because uterine rupture in an unscarred woman is an extremely rare event. We need tens of thousands of women in order to get an accurate number. The fact that Zwart includes over 300,000 unscarred women is huge.
Take home message: The risk of uterine rupture before labor is extremely rare especially for unscarred women.
* This statistic includes non-induced/augmented, induced, and augmented labors.
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Jen Kamel
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.
I found that obstetricians’ fear of uterine rupture was the greatest barrier to VBAC and is seemingly the pivotal excuse for denying them. Add to this a propensity of doctors and hospitals to set up impossibly strict protocols for women wanting VBACs, and we have a no-win situation for women. These protocols set up a cascade of failure regardless of what the woman wants. Ignorance and fear play a major factor in women’s acceptance of these rules. As a result, VBAC “failure” is high in hospital settings. So what’s a woman to do?