VBAC and Uterine Rupture: What are the Facts?

The VBAC Link – Uterine Rupture Facts & Perspective

Why this podcast?
The VBAC Link is an absolute must if you are planning a vaginal birth after cesarean (VBAC). With over a hundred episodes of birth stories and evidence-based information, this has become a firm favourite of mine.

The VBAC Link is also so much more than a podcast.

The hosts, Julie and Meagan, VBAC parents themselves, have created online VBAC courses for both parents and doulas as well as a blog series that covers all aspects of a VBAC journey and a wonderfully supportive VBAC community.

Even if you have never had a cesarean, the information Julie and Meagan provide could help you to minimise your risk of having one in the future.

Go, check it out!

The episode
The way VBACs are seen ranges from totally normal to very risky depending on where you are and what you know.

The number one risk people tend to think about when it comes to VBAC is uterine rupture. But, how big is the actual risk of that happening and, if it does, how dangerous is it?

I love the fact that Julie and Meagan cover the risk of uterine rupture here rather than shying away from it which they could so easily have done.

Meagan shares that during her second cesarean her doctor told her that if she had attempted a VBAC her uterus would definitely have ruptured.

As you can imagine, those words stuck with Meagan and the fear that came with them was something she had to work hard at letting go of.

So, how did Meagan conquer her fear of rupture?

She dived into the facts, she chose her birth team carefully and she listened to her intuition.

Uterine window, uterine dehiscence & uterine rupture
These are the three classifications of uterine scars and when reading studies it’s important to know which is being discussed.

Uterine window – This is where the cesarean scar becomes so thin that you can see through it but there is no separation of the scar tissue.

Uterine dehiscence – Here the scar tissue is beginning to separate. The uterus has three layers and if one or two start to separate it is classified as dehiscence.

Uterine rupture – This is when all three layers separate.

How do I know if I have one of these?
The short answer is that unless you have a cesarean, you don’t.

While that may sound a little scary the flip side is –

 It is impossible to know how many people with a uterine window or uterine dehiscence go on to have a successful VBAC.

Julie and Meagan point out that as your uterus grows during pregnancy it also thins.

So, if someone gives birth vaginally, we have absolutely no way of knowing how thin their uterus might have been or how many may have had a uterine window.

When researching, it is important to check that the study is discussing rates of actual uterine rupture.

Including cases of uterine windows or dehiscence will make the risk of rupture appear much higher.

But, what is the actual risk of uterine rupture?
*A 2017 study shows that uterine rupture occurs 0.4% of the time in trials of labour after cesarean.

That’s pretty low.

What’s more is that in the majority of cases, both the baby and birthing person were totally fine with no lasting implications for their health.

When you hear the term rupture it is easy to imagine a uterus exploding but as we saw earlier, that’s not what is meant by rupture.

Often, there are signs that a uterus is beginning to rupture and action can be taken to prevent a full-blown emergency.

A few more facts for you
– Only 6% of uterine ruptures are complete (where the whole scar separates) or catastrophic with the loss of infant life.

– Put another way, if you try for a VBAC your chance of a catastrophic event occurring is 1 in 769.

– The chance that any kind of rupture will occur is 1 in 240.

– It is so rare that the birthing person’s life is lost in the case of rupture that there are no statistics on this.

For perspective:
– The neonatal mortality rate in the USA in 2017 (for ANY birth) was 1 in 172.

– Your chance of having a heart attack is 1 in 160 per year.

 – 1 in 216 is the chance that the person you are dating is a millionaire.

A study for you
A study carried out in Canada over a period of ten years looked at 114,933 births. They documented:

– 39 cases of uterine rupture (0.03%)

– 18 cases of full rupture ( 0.02%)

To wrap up
Do uterine ruptures happen? Yes.

Are they common? No.

Should you ensure that you and your VBAC team know the signs of a possible rupture? Yes.

Should you let the very small chance of a rupture stop you going for your VBAC?

I can’t answer that for you but I hope that by reading this post and exploring The VBAC Link, whatever decision you come to will be based in fact and not fear.

Did you have a VBAC?  What, if any, were your fears?

Did those around you hold more fears than you did? How did that affect you?

I’d love to hear from you.

Until next time!

*To see the studies referred to please go to the show notes for this VBAC Link episode.

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By emilywills

Emily Wills is a doula based in Stockholm. She believes that birth can be a beautiful and empowering experience and started this blog as a way of sharing some really great podcasts. She is also a mother of three and an enthusiastic runner.

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