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.
Women who have had uterine ruptures and lost their babies have endured some of our greatest fears. But they are part of our community as well. When the VBAC Facts Community, a Facebook group, was opened to the public, we welcomed and embraced the parents who joined us after their loss. Often they felt like they were no longer part of the birth community. They didn’t know where they fit in. They felt isolated and yet they wanted to share their story. We had many loss moms as members and many parents who were planning VBACs who wanted to hear their stories.
Internal bleeding from uterine rupture can cause referred pain through the phrenic nerve which can present in the shoulder. Shoulder pain is sometimes not included in lists of uterine rupture symptoms, but I have seen it cited multiple places (see below) and have had conversations with OBs, nurses, and anesthesiologists who have experienced uterine ruptures with shoulder pain. I’m also aware of two cases where the uterine rupture diagnosis was delayed because staff was not familiar with the incidence of referred pain.
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?”
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 planned VBAC to the risks of a repeat cesarean or the risks of a first time parent. However, it is a misleading to compare the risks of birth to non-birth events.
There is a bit of myth and mystery surrounding what the American College of OB/GYNs (ACOG) says about VBAC, so let’s get to the facts, straight from the mouth of ACOG via their latest VBAC guidelines.
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