Updated: Mar 4
Planning a VBAC after a previous caesarean birth can be an interesting journey, and your care providers will want to speak with you regarding your plans for this labor because you have a scar on your uterus.
You may hear you have a high risk of having a uterine rupture, and if you have a VBAC, you may be putting yourself and your unborn child in great danger of dying.
Hearing such information may leave you feeling uncertain about what you should do, but I want you to listen to the facts about uterine rupture before you make up your mind about the type of birth experience you are going to plan.
Uterine rupture risks need to be explained in great detail to mothers pregnant after a previous caesarean.
Let's just be clear, and to the point, the risk of uterine rupture is minimal. Women have an 0.7% chance of having a uterine rupture. That's 1 in 1'146 pregnant women and a 2-3% chance of having a uterine rupture if she's had an induction performed.
Let's be clear about everything.
Women who attempt a VBAC have a 72-75% chance of having a successful VBAC and if she's had a vaginal birth before her VBAC rate increases to 85-90% based on the RCOG 2015 Greentop guidelines.
It is a very serious complication that rarely occurs, but we need to contextualise everything so you can understand what it is and how it occurs.
Uterine rupture85It's important to know that most uterine rupture cases are not uterine ruptures cases but scar dehiscences. Knowing the difference can be confusing but it's best to understand the difference before your labor begins.
But will you really rupture? And die?
Do you need to focus so much on uterine rupture?
No, you don't need to superimpose on having a uterine rupture. But, you should make it your business to know all the facts surrounding uterine rupture and the link it has to women planning a VBAC and women having a repeat emergency and non-emergency c-section.
There have been a number of studies conducted on Uterine Rupture which prove that uterine rupture is connected to a previous caesarean section and the use of prostaglandins, so we need to be extremely mindful about the type of interventions and augmentations we allow during labor.
But, Before we get on, let's establish the difference between uterine rupture and scar dehiscence.
Uterine Rupture: Is when the scar tears open and this can happen during pregnancy or during childbirth. This is a real complication that may expel the baby into the mothers abdomen. It is categorised in two stages. Complete and incomplete.
Scar Dehiscence: Is when the scar slightly separates from the inside out and this is rarely catastrophic. Scar dehiscence is more common than uterine rupture.
You have an extremely small chance of having a uterine rupture. It's a very rare complication that rarely happens. The research suggests that you have under a 0.07% chance of having a uterine rupture. So out of every 1,146 pregnancies, 1 woman will experience a uterine rupture.
And remember, the research also suggests you have an 80% chance of
Copyright 2015 J. Y. Woo et al. [CC BY 4.0]
having a successful VBAC and an 85-90% chance of a successful VBAC if you've had a previous vaginal birth.
Who can have a uterine rupture:
Any woman can experience a uterine rupture even if you do not have a scarred uterus. It's quite agitating because mothers are not told this information.
- Women who have had a previous caesarean section. It's said that women with a vertical scar on their uterus have a higher risk f having a uterine Rupture.
-The use of prostaglandins on a mother attempting a VBAC
- Augmentation of labor
What are the signs of uterine rupture?
There is no set symptom to describe uterine rupture because some women have no signs, it can just happen with no warning signs. But Some women describe the feeling:
- A pop, explosion in their uterus
- Lot's of vaginal bleeding
- Not being able to breathe
- Extreme pain between contractions
- Abdominal pain
- Previous uterine scar pain
- Low heart rate for mum and baby
- Low blood pressure
- Fetal distress
- No or extremely slow labor progression
How long do I have to survive a uterine rupture?
Deciding if you're having a uterine rupture can be extremely hard because the outcome, if not picked up early enough, can lead to fetal and maternal morbidity.
So the time between finding the uterine rupture and getting the baby out is very crucial.
Can a mother and baby die from a uterine rupture?
Yes, but remember..... It's such a rare situation and not all uterine ruptures are true ruptures or catastrophic. If the uterine rupture is caught on early enough mum and baby may have a better outcome.
Is Uterine rupture the only dangerous emergency that can happen?
No, it's not, but it's the most talked-about emergency that can occur during your vbac birth, pregnancy and as you can imagine during your c-section. Have you heard of HIE?
Is my scar tissue still strong?
Your uterine scar, now you've had a previous c-section, is not as strong as it was before the surgery. But that's not to say it is weak or it will tear open. No! Every surgery you have will make it weaker and weaker. But just to recap, uterine rupture is extremely rare.
What affects can a uterine rupture have on mum and baby?
Remember, uterine rupture is an extremely rare situation. The problems mum may experience are:
- She may have a haemorrhage
This is when the mother loses a significant amount of blood during birth but in this case because of the rupture.
- Hypovolemic Shock
This is a condition that is a result of severe blood or fluid loss from the body which could stop your organs from functioning, including the heart.
- Bladder injury
- Anoxia -
is when the blood completely loses its oxygen supply.
- And of course DEATH
Uterine Rupture symptoms for the baby:
- Hypoxia & anoxia
- Neonatal intensive care unit admission
AND OF COURSE DEATH
If I have a TOLAC, am I at a higher risk of uterine Rupture?
There are many studies that suggest you have a high chance of having a successful TOLAC. One study quoted, women had an 86.1% successful TOLAC out of the