VBAC risks

[javic]

I'm planning a VBAC at RPA birth centre and would like to learn much more about the risks of uterine rupture.

I've heard numerous times that the risk of rupture is between about 0.3%-0.7%.

What I wonder is what happens if the uterus does rupture?

I know it is off to an emergency c-section, but how long do you have to get the baby out?

I read somewhere that outcomes are best if it is done within 30 minutes but this seems such a short time to diagnose a rupture, then to get all the medical professionals and operating theatre ready, to get the epidural or anesthetic administered and then get the baby out etc.

I read the chances of the baby dying are extremely low in this case, but I was also told the chance of baby dying, if there was uterine rupture, was 1/10. That seems bloody high to me!! The risks of uterine rupture are maybe 1/200 which is also bloody high if you ask me. Considering so many women labour every day, 1/200 means a lot of women must experience uterine rupture in Australia every year.

Has anyone here been through a uterine rupture?

Also, if you are considering a VBAC at home, how on earth do you have the courage in face of these statistics. I would be terrified!

[Nai]

I planned a VBAC with DD2 and ended up with and emergency c/s due to uterine rupture - you can read my birth story here https://www.bellybelly.com.au/forums...ival-long.html

Was I worried? A bit, but she was out within 25 minutes and there was no panic or rush etc in the theatre. I did my research and knew what to look for in the case that things started to go pear-shaped and made sure that I had good support with me. Yes we were lucky but there are a few of us on BB who have had ruptures and been ok, however there are many more successful VBAC'ers who can share their experiences.

Would I go for a VBAC again? yes. Would I recommend other go for it? Absolutely.

[Michelle71]

RPA birth centre is literally across the corridor from the operating theatres and as a tertiary hospital they also have 24 hour theatres and 24 hour anaesthetics.

My DD was a successful VBAC after the emergency c-section for my son at RPA. He was breech, stuck and in distress despite a wonderful labour and progression to 7cm drug free. We were in OT in well under 30 minutes. If it is truly an emergency c-section you may have a general anaesthetic (as I did) rather than spend time attempting an epidural. This can occur within a few minutes so no time delay at all.

There are similar statistics for uterine rupture with an intravenous inducted labour as well but there is far less hysteria associated with inducted births compared to VBAC's. If you are attending the birth centre you will not have an epidural and the sensation for detecting uterine rupture is still intact and not masked by the numbness of an epidural.

This baby is an intended VBAC as well and I have no fears about uterine rupture as it is a very, very small issue in comparison with so many other potential complications. We will be going drug (and epidural) free so sensation of birth will be uninhibited by masking. A VBAC is a wonderful result if you can achieve it for so many reasons but the state of your head and your belief in yourself, your body and your support people is paramount to a positive outcome.

[Arimeh]

I did my research and knew what to look for in the case that things started to go pear-shaped

This is exactly the thing - education. If you educate yourself as to what the signs are that your uterus is rupturing - then you minimise your risk of something terrible happening. Most of the tragic uterine rupture stories I have heard about ending in a stillborn, have been when the mother was given an epidural. With an epidural you can't feel if something is happening, which is the best early warning system you will ever get.

VBAC is definitely possible, but you need to be in the right conditions, and have the right support - and know how to minimise your risk of rupture.

[Ryatha]

:yeahthat:

Just like the others, do your research, know all the details, from both drs and others. Drs will give you the worst case scenario which is scarey so just make sure you go into labour armed with knowledge and a team who supports you.

[javic]

(sorry the title above was supposed to be my image verification!!)

thanks so much guys for your responses and especially Nai for sharing your story which was beautiful and made me cry!

i have read a couple of other stories of uterine rupture and although both mums and babies survived those mothers were very anti-vbac after their experience.

the difference was, i think, that those women were completely uneducated as to the risks of vbac or rupture, had no idea what they were in for, had no idea that their induction contributed to the risk and just so completely oblivious to what they were getting themselves into - just blindly following what their doctor advised.

they both also commented though that they felt something was wrong. the pain that they felt was not a safe pain and they had both told the nurses/drs that they needed surgery immediately. so i hope that rupture always makes itself so obvious.

i have read about the signs as below, but are there any others you think worth mentioning from personal experience?

i have never experienced labour, during my first pregnancy i experienced a twisting ovarian cyst at 39 weeks and needed surgery. they insisted we had to get bubs out then too. i was in a situation where all my months of research on birthing, hypnobirthing, induction, the cascade of interventions etc, all out the window and i was armed with absolutely no information to base my decision on. i phoned my doula and she sounded stumped too. the only option was c-section.

anyway here's the list of signs to look for - any more to add?

Several symptoms have been identified, but do not necessarily occur with every uterine rupture. Signs of uterine rupture that may or may not be present.

* Vaginal bleeding

* Sharp pain between contractions

* Contractions that slow down or become less intense

* Abdominal pain or tenderness

* Recession of the fetal head (baby's head moving back up into the birth canal)

* Bulging under the pubic bone (baby's head has protruded outside of the uterine scar)

* Sharp onset of pain at the site of the previous scar Uterine atony (soft muscles)

[Arimeh]

Obviously I never had a rupture with my VBA2C, but when I was discussing it with my midwife, she just said to let her know if I felt pain between contractions. Because once a contraction is finished, you should have no pain whatsoever (until it starts back up again!)

[javic]

First, thanks Arimeh for the tip - that is very good to know!

Nai, just in case you come back - your story mentioned that the midwife wanted to monitor the baby - did the baby shows any signs of rupture - irregular or slowed heartbeat?

How long was it from when you noticed a problem until Juliette was out?

She is lovely - beautiful eyes!

And thanks for helping me learn about this

[Nai]

Juliette showed no signs of any adverse effects, she was absolutely fine and her heartrate was strong the whole time. The monitoring was because of the meconium when my waters broke. I think it was less than 25 minutes from when I felt things were wrong until she was out - it was so quick. I was at the private part of the Royal Womens so everything was ready to go at a moments notice.

My main signs were the pain that didn't go away when the contractions stopped, the fresh bleeding and the feeling of the baby pushing out through the front of my uterus.

[javic]

one more question...

if you have a rupture, does this increase your chances a huge amount of having a rupture again in a subsequent pregnancy?

do they insist on c-section in any subsequent pregnancies?

[Fleur]

Just coming in to wish you well, the others have said it all perfectly

There are similar statistics for uterine rupture with an intravenous inducted labour as well but there is far less hysteria associated with inducted births compared to VBAC's.

and don't forget this, they will go on all day about VBAC risks, but I never heard of the risks of rupture when inducing via synto with my first 3 kids ... not the first two who would have been induced or the third who was....it wasn't mentioned. Hmmm. Methinks they might pick & choose a bit of what they tell you

[~mamaspice~]

I read the chances of the baby dying are extremely low in this case, but I was also told the chance of baby dying, if there was uterine rupture, was 1/10. That seems bloody high to me!! The risks of uterine rupture are maybe 1/200 which is also bloody high if you ask me. Considering so many women labour every day, 1/200 means a lot of women must experience uterine rupture in Australia every year.

The 1/200 chance of rupture does sound high, but you have to remember that it is 1 in 200 VBACing women. I think it equates to about 1 rupture in every 22000 overall births.

Good luck with your decision.