Rupture happens

Tuesday, April 17th, 2018 at 9:31 pm

Select at random from the massive group of women who’ve had c-sections in the past twenty years, and ask them about rupture.

Chances are they’ll tell you that uterine rupture is common and life-threatening for those who choose to VBAC (have a vaginal delivery after a c-section.)

They’ve gotten this impression from doctors, hospitals, and insurance companies who, after a ACOG (American Congress of Obstetricians and Gynecologists) position paper in 1998 decided that VBAC was too risky to support.

On the other hand, talk to a bona fide crunchy-granola homebirth mama and you might get the impression that uterine rupture doesn’t actually happen – at least, not with any frequency.

Neither are quite true.

Rupture happens.

Some degree of separation along a former uterine scar occurs in up to 3% of VBAC attempts. In less than 1% of VBAC attempts, a complete separation of the scar occurs, requiring an emergency c-section to avoid life-threatening complications (in other words, a TRUE emergency c-section, as opposed to the much more common “failure-to-wait” section.) In the remaining 1-2% of VBAC attempts that result in rupture, the separation is small and/or partial and requires no treatment other than monitoring hemoglobin levels. (Data from VBAC.com.)

Generally, these incomplete ruptures are caught by manual examination after a VBAC. The attending physician sticks his hand inside the newly delivered mother’s uterus and palpates the incision scar to see if there are any holes or weak spots. Yes, it really is as awful as it sounds (It was more painful for me than the previous 42 hours of unmedicated childbirth.)

My rupture wasn’t identified in that manual sweep. It was discovered by ultrasound a week later when I went back to the hospital with intense abdominal pain. That we know of, the pain wasn’t caused by the rupture – the pain resolved on its own before I left the ER.

My hemoglobin had dropped, but it had stabilized at the next check, a couple of days later at my doctor’s office.

I never required any treatment for it.

It won’t prevent me from getting pregnant again or having another VBAC, although it does mean that I would be wise to give my uterus plenty of time to heal before I subject it to more contractions (in other words, I should try to avoid labor until Beth-Ellen is at least 18 months old.)

Moral of the story?

Rupture happens. It can be life-threatening, but it isn’t necessarily so. Those considering a VBAC (or who have been talked out of a VBAC) deserve to hear the whole story – instead of only hearing worst-case scenarios or empty reassurances.


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