If you were to rupture, when would it happen?

If I was unlucky enough to have my uterus rupture during labour, at what stage would it happen?? Does it ever happen in early labour??

I don't want to go to the hospital too early, I did last time even though I knew I wanted to stay home as long as possible. I wish I had of just got checked straight away and came back home! So this time I really really want to stay at home as long as I can. But I'm worried that a little bit of fear in the back of my mind about rupturing might make me want to go in earlier than I should to make sure everything's ok.

Soo.......if a rupture was to occur is it unlikely it would happen in the early stages of labour, and a lot more likely to happen towards the end?? If this was the case I would feel more relaxed staying home for longer I think. Does anyone know when the majority of ruptures occur?

Ahh chicky :hug: It is a tough one, thing is IF it happens (and you know it's a very BIG if) it can happen any time during labour. I think the best thing to be aware of is the signs and to be aware of them if you decide to labour at home. Being aware of what can happen and what you will do if you feel like something is happening that isn't meant to happen should be part of your birth plan.

This was one of the things I was worried about as well and although I knew that it would be good for me to labour at home, I knew that I would probably feel much more comfortable labouring in hospital, turns out I never got the chance but I had planned for it all well ;)

I'm sure you are already but read read read - the more you read, birth stories, birthing books (all the good ones!) the more your confidence in your scar and your body will increase that you can do this and yes you can be aware of the risks but not scared of them ITMS.

I was at 4cm when mine started rupturing and I was dilating quickly. My contractions were 2min apart for 30sec and my waters had broken when we decided to go in to hospital. However, we are only 5 min drive away.

I think IF it's going to rupture, it could happen at any stage in labour.

I understand what you're feeling. In the back of my mind I was always thinking 'what if I'm doing the wrong thing?'. But I started to read up on VBACs and listened to a hypnobirthing cd every night and did a class with a physio on breathing and positioning. I came to be more in tune with my body and while I still had a bit of fear I felt that bit more confident about trusting my body and knowing myself if something was going wrong.

I labored at home for as long as I could manage. I got to the hospital when I was 7cm and starting transition and DD was born 2 hours later.

Oh, one other thing that helped put my mind at ease was that my ob did an ultrasound on my scar to measure it's thickness and he was quite happy that it was thick enough so that was reassuring. Maybe this is something you might consider?

It's worth also mentioning that a rupture can happen during pg as well. So labour is not the only risk, ITMS.

Mine was likely at the start of labour, although we weren't aware it had happened, I had a half hour drive to hossy. My daughter didn't make it.
Most do occur while in established labour, often after a long period of time.
But it is hard to say the big 'when' (obviously the chances of it happening are low).
I know of other ladies that have ruptured without labour, although this is very rare.
You have to go with whatever you feel comfortable with.
Sorry if I have scared you, but it helps to decide if you aware of all the risk factors.

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Oh, one other thing that helped put my mind at ease was that my ob did an ultrasound on my scar to measure it's thickness and he was quite happy that it was thick enough so that was reassuring. Maybe this is something you might consider?

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Just wanted to mention that although scar thickness is an indicator, it doesnt always mean thick scar, all will be well. Mine was measured at 36 weeks to be 7mm, a good thickness and by 40+6 it ruptured. My friend was measured at 38 weeks to be 1 mm scar and didn't rupture.

This pregnancy, my scar is been measured, but I don't put all my faith in it.

Heaven, are you interested in rupture from a c/s scar, or all ruptures? Because it's not always a VBAC situation. If you wanted to split out the VBAC from all uterine ruptures I'm sure you could get some figures somewhere. But it's probably going to be anecdotal as to when VBAC ruptures occured (ie before or at what stage of labour).

Heaven, just realised it was you that posted, sorry.
Glad all going well with pregnancy.
Just to point out I had had 2 successful Vbac's after my initial emergency section with my twins in 2002. I had a Vbac in 2004 and one in 2006. Also as you know I'm a Doula so help women through Vbac, not trying to put you off, far from it. It is a wonderful experience.
Hope all goes well.

The big what if... There are not hard and fast rules - It all really depends. According to the research, you have 0.2% chance of rupturing, which is the figure often stated. What is often not stated is that 1/3 of that stat who were VBAC's that ruptured didn't even rupture along the scar line, but elsewhere in the uterus. Another thing not mentioned again is that 75% of women who rupture have NEVER had a c-section. The greatest risk to rupture in all cases is intervention, usually done all in the name of fitting into the institution's generalised timeframes. You have a 5-6 times greater chance of rupture if you are induced or have any oxytonic drugs to "Speed things up". You have a 3-4 times chance of rupture from artificial rupture of the membranes (because if baby isn't in the best position now baby and mum's uterus has to work harder to push them into it without the fluid to help). A 0.2 chance of something going wrong in life is tiny. You have more chance of having a car crash on the way to the hospital (of course those figures don't comfort the people who find themselves in the 0.2). On the flip side, if you stress out because of the fear of not being in the hospital it's going to create just as much risk because it may prolong your labour, put extra tension in your muscles and produce labour counter-productive hormones. I can only give you the figures to try and ease your mind, but in the end you have to decide what the risk/benefit is from going or not going to the hospital early. As Eluned has suggested getting an ultrasound of the scar might help ease some of your fears.

Refs:
Betty-Anne Daviss, Kenneth C. Johnson, Ina May Gaskin, "Vaginal Delivery After Caesarean Section", BMJ: British Medical Journal, Vol. 323, No. 7324 (Dec. 1, 2001), pp. 1307-1308

Shirley L. Brengman and Margaret K. Burns, "Vaginal Delivery after C-Section", The American Journal of Nursing, Vol. 83, No. 11 (Nov., 1983), pp. 1544-1547

Jeanne-Marie Guise, Marian S. McDonagh, Patricia Osterweil, Peggy Nygren, Benjamin K. S. Chan, Mark Helfand, "Systematic Review Of The Incidence And Consequences Of Uterine Rupture In Women With Previous Caesarean Section", BMJ: British Medical Journal, Vol. 329, No. 7456 (Jul. 3, 2004), pp. 19-23

:hug: No advice just lots of positive energy and thoughts your way hun xxx

Big hugs Heaven, its hard territory getting your head around a VBAC I know. Jennifer & Yeddi have made the same points I was going to make - that rupture risk is not just confined to labour, it can occur during pregnancy too. And as Yeddi points out so well, its worth taking the time to put the risks into perspective. From a statistical point of view its easy though - I can relate to the same thoughts around "what if it happens to me?"

We planned to birth at home with DD but it didn't eventuate that way, however when working through all this with our Independent Midwife, we talked a lot about what she looked for as early signs that might indicate something was not right, and early signs specifically to look out for if a rupture may be imminent. I'm not suggesting that it can all be predicted like clockwork, but there are some definite things that you can make yourself aware of that might help you feel more comfortable in the early stages of labour and allow you to remain at home.

Good luck.

Oh bugger. I was hoping it might be some easy answer that it's extremely unlikely in early labour and then I could just put it out of my mind altogether, lol. But I will get there. Just have to do some more reading until I feel confident. Had my first hospital appt yesterday and they gave me a pamphlet on VBAC which wasn't actually trying to scare me!! Just said some of the risks but that they were very rare and that there is also some risks with a repeat c/s. It even said 'It has been estimated that, during VBAC, risks to the baby are similar to those faced by a baby who is the vaginal first-born to any mother'. So that made me feel good that the hospital supports it!

Tan- thanks! Do you have any suggestions for good stuff to read?
Nai- I'm about 1/2 hr from the hospital. Lucky you were only 5 mins!
Eluned- thanks, I might ask about the u/s
Jennifer- yeah, I'm interested in the VBAC rupture stats.
ButterflyForever- That's ok, thank you for your info! It's all helpful.
Yeddi- Thanks so much for that and the references too!
boomba- thank you.
Infinity- Thank you. I do need to find out what all the early signs are of a possible rupture. That would help me feel more comfortable and in control if I know what to look out for.

Thank you everyone!!

Heaven, I used that same statistic from the brochure when any of my friends and family questioned me about VBAC. I was also 30 minutes away from hospital (usually 20 but had to drop DS off at the inlaws first). I lasted so long at home by having DH help me with back rubs, getting in and out of the bath and shower, being a physical and mental support for me. I also had a tens machine which only came off when I got in the bath or shower. So having a good support person with you is essential.

Last time I don't think I was prepared enough with how to cope with the pain, so I was a bit scared which made me go to hospital earlier too. I mean I knew, breathe, visualise, relax, etc etc. But they're kind of broad ideas. This time I need to be more prepared about exactly what I can try. I have ordered Juju Sundin's Birth Skills book! I am going to make DH read it too so he is there to remind me and encourage me. He was great last time but I think also felt a bit lost. I'm going to make sure he knows exactly what to do.

That's great Heaven, that is going to be the best way to prepare, read, read, read :hug: That book sounds good!! "The Thinking Woman's Guide to a better birth" is great also. I have a copy if you want to read it.
Fear will make your labour so much more worse for you and more painful..... so understanding your fears going into labour will help immensely with that :)

That's a great book Heaven! Get your hands on a copy of Gabrielle Targett's book called A Labour of Love. That will really inspire you too.

I found that having DH know specifically what things he can do really important because he would remember something that I forgot about. When you're in the moment of a contraction, alot of the knowledge and common sense can disappear, whereas DH is more clear headed and can say how about you try this or what about this...I made my DH a list of things he could do and things he could remind me about and we practiced them throughout pregnancy. I listed them in order of preference too. When we practiced there were some positions that I loved, but when I was in actual labour, I hated it so he moved onto the next thing on the list :)

Juju's book is great, and The Thinking Womans Guide I really found helpful to put things in perspective.

Have you considered hiring a doula Heaven? It might even be worth talking to the hospital about their policy for managing VBACs. Most will want some kind of monitoring, often have time limits on dilation and pushing stages too. At least when you know all this you can start to prepare for things and feel a bit more in control about your decisions.

I just wanted to add to what all have said...

Rupture can occur during any pregnancy at any time or during labour. It can happen in a first pregnancy, subsequent, vbac's or ecs. And no, uterine wall thickness is no indicator of chance of rupture, they measure a small segment and the uterus expands unevenly and stretches further or less in certain places.

A recent vbac study compares ALL pregnancies inc. vbac and discusses rupture and dehisences (which are often bundled together in stats) I have not found a freely available copy, unless you have a subscription to Science Direct or similar but I do have a pdf copy if you would like me to email it to you.

It is called A New Perspective on VBAC, let me know if you would like it.

Sarah :)

:hug: to you Heaven.

I think what stopped me from stressing about rupturing (at least until she was pressed against my pelvic bone and I thought I was rupturing!) was knowing the signs of rupture in the first place. Most ruptures (from my reading) come with warning signs, so its not like your tummy just explodes or something without you knowing about it ;)

I was told to look out for any abnormal bleeding between contractions, and pain between contractions. I'm sure you remember from your first labour that you feel no pain between contractions, so as long as you still have that, I think you are pretty safe :hug:

Its a big ride you're going on - but that doesn't mean you can't do it :hug:

Thanks everyone. My fav stat is that the risk is the same as that for a first time mum induced with the drip. No one bothered to tell me about that risk when they gave me the drip with DD so they musn't have thought it was a high risk huh? But apparently they have to put all these restrictions on VBAC mum's, grr...

I am going to get a copy of 'Silent Knife' heard it's good.

studentmum- thanks, I will PM you my email.

Mel- I remember having no pain in b/w contractions. But I remember too that when I had a contraction all the pain was down low like where my scar is, so I hope that doesn't freak me out! lol.

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Thanks everyone. My fav stat is that the risk is the same as that for a first time mum induced with the risk. No one bothered to tell me about that risk when they gave me the drip with DD so they musn't have thought it was a high risk huh? But apparently they have to put all these restrictions on VBAC mum's, grr...

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Defies logic, doesn't it?
I'm actually quite mad that I was subjected to that risk for no good reason, especially knowing the OB in question would not have supported a VBAC if I'd ended up with a c/s.

Good luck with your VBAC, by the way. Good birthing to you and your baby!

Another question!!

When I had my OB appt she told me I wouldn't be able to have a long labour like with DD, they want me to dilate quickly (sure thing! no problem :rolleyes:) because it increases the risk of rupture the longer labour goes on because your uterus gets tired. Is this true? Is there any research to support this?? How does the muscle getting tired mean the scar is weaker??

Heaven - personally - I think its a bit of an old wives tale - same as the big baby theory will rupture your uterus ;)

Oh yeah she also suggested I have a scan to see if the baby is too big and decide on a c/s, or if I haven't gone into labour before my due date to have a c/s, pmsl, I almost laughed at her.

Ahhh gotta love these care providers that say that are pro VBAC, but are soooo full of restrictions that its ridiculous. Just be happy in what your own research digs up as opposed to a worried OB not willing to take risks.

It just occurred to me...if I have a long labour she said we may need to speed things up with the drip, which increases the rupture risk by 50% Sooo.......she is willing to increase the chance of rupture with the drip instead of letting it happen naturally and most likely not increasing the chances at all, wtf??

Bizarre.

I am just going to stay home as long as possible so they can't say how long I've been in labour and refuse internals so they can't tell me I'm too slow. PITA!!

Yes I think its ridiculous she suggested the drip to speed things up. How about letting you relax without restrictions and worries - that will make it happen quicker for you than any drug. Not to mention the risk that it carries - my god - I would never even think about being given the drip to speed things up, thats just playing with fire I reckon.

I say your idea to stay at home sounds great. Are you getting a doula?

I don't have a doula but I have a student midwife, Sara from BB! Who is also a qualified doula aswell, lucky me!

Awesome, you're in good hands then.

Have you read any VBAC stuff yet? I've got heaps of books coming to prepare for my second one. Mostly focusing on pain relief and how to do it calmly - ie, without screaming.. LOL

I've read Juju's birth skills, and now I'm on to Ina May's Guide to Childbirth, and then I want to read silent knife. Any suggestions for me??

LOL, I was actually all silent mostly with DD except when I had a premature urge to push and was making some odd noises, lol. This time Juju is telling me to yell!! lol.

Heaven - are you having bub at a public or private hospital? Because you've had a previous CS, do you need to see an OB? is that why?

Haha I yelled and screamed when appropriate.. LOL.. not during the pushing stage though for some reason? My old midwife from Selangor always said "open mouth, open vagina".. haha!!

I read silent knife, spiritual midwifery, um another book that the name escapes my mind but it was about home births, birth skills.. and a few breastfeeding books. That was for last time.

Now this time, I'll read spiritual midwifery again, I've got books on their way from the UK - Ina May's Guide to Childbirth is one of them, New Active Birth and Birthing from Within. I am also in the middle of The Water Birth Book that one of the lovely BB ladies let me borrow from her.

So I *think* I'm covered with reading material.... of course I'll do a refresher with Juju and read her book again, and I'll be getting DH to read some stuff this time too. Dunno how we will get time for all this, but I'm sure we will make time!!!

Also am going to do a hypnobirthing class if we make it up to queensland :)

ETA - Shanti - because of previous c-sections, we are classed as high risk and will always need to see an OB if we go public :)

Shanti- public but everyone has to see an OB for 1 appt at the start. And apparently I have to see them again at 36wks to discuss method of delivery :rolleyes:

Mel- thanks for that!! pmsl, open mouth, open vagina, I'll remember that one!