Having a prior uterine surgery increases the risk of uterine rupture. The relative risk is still low, but it’s there. Other factors can push that risk higher (such as induction.) But sometimes there is no “reason” for a uterine rupture other than a prior cesarean. Uterine rupture stories illustrate that even though the risk is ~ 0.4% (among those with one prior low transverse cesarean in a spontaneously laboring VBAC), that small number impacts real parents & babies.
A VBAC study out of Canada reported, “Absolute rates of severe maternal morbidity and mortality were low but significantly higher after attempted vaginal birth after cesarean delivery compared with elective repeat cesarean delivery.” After reading the abstract, and full text, I could quickly see how this study will be misinterpreted by many, so let me walk you through it.
So what matters more: Our personal experience? Or the conclusions of medical evidence? I suspect that most of my readers would say, the evidence. Hands down. And that is what most people believe… until they experience a bad outcome. That’s when things become more complicated. That single event can override all their knowledge. Everything they believed to be true. Suddenly all those statistics from the research come flying off the page. They are no longer just a number. They are now associated with a face… a baby… a parent.
ACOG’s 2010 VBAC recommendations affirm that VBA2C (vaginal birth after two cesareans) is reasonable in “some” women. But they remain silent on VBAMC (VBAC after multiple cesareans.) Some have interpreted that silence to mean that ACOG does not recommend VBAMC, yet ACOG is clear that women shouldn’t be forced to have cesareans.
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.
Most women planning a VBA1C (vaginal birth after one cesarean) are aware of the risks of uterine rupture. However, women planning their first vaginal birth or VBA1C need the WHOLE picture so they can really work to prevent an unnecessary cesarean.