I have heard countless women say online that their doctors don’t recommend VBAC (Vaginal Birth After Cesarean) due to the risk of uterine rupture. In fact, every single woman I know in real life who had one c section was told the same thing by their physicians. This made me wonder how common is a uterine rupture? What is the real risk? Is this a big risk after one c section or a scare tactic? So I decided to do a bit of research.
The language used by doctors certainly sounds scary. I’ve had friends told that if they attempt a VBAC, they risk infection, death of the baby and even death of the mother. It is enough to scare anyone out of attempting a VBAC delivery. Some people are under the impression that the risk of a uterine rupture is very high. A few friends have reported that their doctors presented it as an almost certainty. So what is the real risk?
The National Institute of Health conducted the largest study ever done on the risk of uterine rupture after a previous c section. The study looked at all women delivering at 19 large medical centers around the country over a four year period. In the group of women attempting a VBAC delivery, the percentage of actual rupture was 0.7 percent. The absolute risk was determined to be .46 per 1000 births, which is less than one half of one percent.
There are certain factors that increase the chance of a uterine rupture. A big factor is labor that is induced. A study conducted at the University of Washington and published in the New England Journal of Medicine looked at women in Washington state from 1987 through 1996. This study found that the risk of uterine rupture was higher when labor was induced with prostaglandins and highest when pitocin was used to stimulate labor. In their sample, the rate of rupture was 24.5 per 1000 when pitocin was used to induce labor.
According to the National Center for Health Statistics, the rate of maternal death is on the rise in recent years. One hypothesis is that the increased number of c section births is part of the reason for this increase. The US has one of the highest c section rates in the developed world (31.1%), and coincidentally, one of the higher maternal death rates. The risk of problems such as infection, reaction to anesthesia and blood clots are higher among women having c section births. A study published in the November 17, 2007 issue of the British Medical Journal showed the risk of maternal death was double in a c section vs. vaginal delivery.
The studies about the risk of uterine rupture looked at women who had one previous c section. The risk would be higher after repeated c sections. The decision between VBAC and repeat c section needs to be made on a case by case basis between a woman and her health care provider. If you want a VBAC and your doctor has told you the risk of rupture is high, you may want to seek a second opinion before making your decision.
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