Uterine Rupture: A Look At 20 Peer-Reviewed Publications

by Birth Without Fear on September 6, 2011

uterine rupture

*Edited to add:  While I emphasized this many times throughout the post, it has been brought to my attention that others are sharing this as a VBAC only post/percentage. I want to clarify that .07% is for all pregnant women, including no previous scarring, scarred from any trauma, VBAC and anomalies (.012 when only non scarred and .07 with all). VBAC rupture rate is closer to .3-.5%. Still very small, but higher when isolated to just VBAC’s.

Uterine rupture has become a big risk over the last few decades. At least that is what pregnant women are told. Especially for moms who want to birth vaginally after a previous cesarean section. A cesarean is major surgery and a scar and scar tissue are a result. The body is amazing and can heal and adapt very well. Just how much of a risk is uterine rupture to a mother?

I found this article recently on Medscape Reference. It is a summary of what 20 peer-reviewed publications have found when it comes to uterine rupture in pregnancy and birth. Let’s break it down.

Sources

The peer-reviewed literature was searched using the PubMed, Medline, and Cochrane databases for all relevant articles published in the English language. The search terms were uterine rupture, pregnancy and prior cesarean section, vaginal birth after cesarean, VBAC, trial of labor (TOL), trial of labor after cesarean (TOLAC) uterine scar dehiscence, and pregnancy and myomectomy. Standard reference tracing was also used.

Articles published from 1976-2010 that described the incidence of uterine rupture and that included sufficient information regarding the authors’ definitions of uterine rupture and of uterine-scar dehiscence were incorporated for review. All studies were observational or reviews. A total of 109 published articles were included for data extraction and analysis.

It is important to know where and how a study (or studies) were done when citing them. There are many factors to consider in how the results were found. These studies were all taken from medical sources and peer reviewed.

Overview

From 1976-2009, 20 peer-reviewed publications that described the incidence of uterine rupture reported 1,864 cases among 2,863,330 pregnant women, yielding an overall uterine rupture rate of 1 in 1,536 pregnancies (0.07%).

We are looking at a large number of women. Almost 3 million! The overall uterine rupture was .07%. Now do we want this to happen at all? Of course not. Anything can happen in life, including when birthing. I trust birth. I respect birth. For birthing women, it is not 1%, not .5%, not even .1%, but .07% of women can experience uterine rupture.

The initial signs and symptoms of uterine rupture are typically nonspecific, which makes diagnosis difficult and sometimes delays definitive therapy. From the time of diagnosis to delivery, only 10-37 minutes are available before clinically significant fetal morbidity becomes inevitable. Fetal morbidity occurs as a result of catastrophic hemorrhage, fetal anoxia, or both. The inconsistent premonitory signs and the short time for instituting definitive therapeutic action make uterine rupture a fearful event.

If a woman starts to have a uterine rupture, there are few signs. A skilled midwife or OB may know what to look for and at the first sign of something wrong, take action. In this .07%, there is 10-37 minutes to get baby out. When uterine rupture does happen, it needs to be addressed quickly, because if not, baby can die. This is why it is so feared (understandably so).

Definition: What is Uterine Rupture?

Uterine rupture during pregnancy is a rare occurrence that frequently results in life-threatening maternal and fetal compromise, whereas uterine scar dehiscence is a more common event that seldom results in major maternal or fetal complications. By definition, uterine scar dehiscence constitutes separation of a preexisting scar that does not disrupt the overlying visceral peritoneum (uterine serosa) and that does not significantly bleed from its edges. In addition, the fetus, placenta, and umbilical cord must be contained within the uterine cavity, without a need for cesarean delivery due to fetal distress.

By contrast, uterine rupture is defined as a full-thickness separation of the uterine wall and the overlying serosa. Uterine rupture is associated with (1) clinically significant uterine bleeding; (2) fetal distress; (3) expulsion or protrusion of the fetus, placenta, or both into the abdominal cavity; and (4) the need for prompt cesarean delivery and uterine repair or hysterectomy.

Although a scar from cesarean delivery is a well-known risk factor for uterine rupture, most events that involve disruption of the uterine scar result in uterine-scar dehiscence rather than frank uterine rupture. These 2 entities must be clearly distinguished because the options for clinical management and outcomes differ significantly.

From this we know that uterine rupture is RARE, but can be fatal very quickly. It is also noted that uterine scar dehiscence is different than uterine rupture. It can be controlled easier and is usually not fatal. If a true uterine rupture occurs, a cesarean section will be needed to save baby and to address the rupture and heal the mother.

Also important to note is that most of the time, even with a previous cesarean section, it is a uterine dehiscence, not a rupture. They are significantly different!

Percentages Found

Meta-analysis of pooled data from 20 studies in the peer-reviewed medical literature published from 1976-2009 indicated an overall incidence of pregnancy-related uterine rupture of 1 per 1,536 pregnancies (0.07%). When the studies were limited to a subset of 8 that provided data about the spontaneous rupture of unscarred uteri in developed countries, the rate was 1 per 8,434 pregnancies (0.012%).

Like previously stated, the risk of uterine rupture in all cases (VBAC, previous cesareans, etc.) is very low at .07%! When they limited the studies to only 8 studies about spontaneous rupture of a uterus that has not been previously scarred, the rate lowered to .012%. So with all factors, including previous cesareans, the rate does rise, but it is still under .1%!

Risk Factors

Congenital uterine anomalies, multiparity, previous uterine myomectomy, the number and type of previous cesarean deliveries, fetal macrosomia, labor induction, uterine instrumentation, and uterine trauma all increase the risk of uterine rupture, whereas previous successful vaginal delivery and a prolonged interpregnancy interval after a previous cesarean delivery may confer relative protection. In contrast to the availability of models to predict the potential success of a TOL after a prior cesarean section, accurate models to predict the person-specific risk of uterine rupture for individuals are not available.

There are many factors taken into consideration in the .07% including uterine anomalies, myomectomy, number and type of cesarean births, induction and more. That’s right, it’s not even just about cesareans. In that .07%, it includes complications for anomalies, traumas from car accidents or falling and INDUCTIONS!

What lowers risk? Previous vaginal births and more time to heal between a cesarean and subsequent pregnancies. There are also unique characteristics to every women’s body, history and pregnancy.

Summary

Even when taking in ALL factors of any kind of situation, after looking at multiple peer reviewed research and 2.8+ million women’s pregnancies and birth, the chance of a uterine rupture is significantly LESS than 1%. It is LESS than .1%! It is .07%.

If you want to have a VBAC, find a care provider (midwife or OB) that is competent and supportive. Show them the research, talk about how to reduce the risk (even though small) of uterine rupture for you and birth your baby without fear!

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{ 74 comments… read them below or add one }

Cindy September 6, 2011 at 5:45 am

Your Medscape Reference link is broken.

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Mrs. BWF September 6, 2011 at 8:02 am

Thank you!!! Fixed it.

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Amy September 6, 2011 at 6:36 am

Great information! I am curious now to know the rates for uterine dehiscence.

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Julie March 1, 2014 at 12:30 pm

I am interested in the rates as well.

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Cindy September 6, 2011 at 8:05 am

The rate for uterine dehiscence can’t really be known … can it? Because in some portion of dehiscence cases, the baby is born fine, and no one knows. The only dehiscence cases that become known are where the mother has another cesarean surgery for some other reason than rupture. Then the doctor discovers the dehiscence (and likely annotates the chart and tells the mother that it was a darn good thing that he was there to save the day, because her uterus was opening, ye gods!!). True rate of dehiscence is unknowable.

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rachel loth September 6, 2011 at 9:43 am

Great info! thank you

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Knitted in the Womb September 6, 2011 at 12:27 pm

I think it is important to point out that the 0.07% rupture rate is for ALL pregnancies. The rupture rate for women attempting a TOLAC is higher. I still think it is definitely low enough that care providers should not be using it as a reason to deny TOLAC or to try to scare a woman out of choosing TOLAC, but it isn’t 0.07%

Previous research has indicated a rupture rate of about 0.5% for TOLAC, but that reseach typically incorrectly includes dehesience in the numbers, so it is likely high. So the actual rate of rupture in TOLAC likely remains somewhere between 0.07% and 0.5%

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Mrs. BWF September 6, 2011 at 1:10 pm

This post is not just about VBAC’s. I am working on that post to come out soon. ;)

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Christine September 6, 2011 at 3:53 pm

But you mention vbac in the first sentence and have a picture of a scar on top. I think it needs to be made clearer that this .07% rate is for ALL pregnancies NOT vbacs.

The NIH consensus last year reviewed a ton of studies and found that the risk for VBAC is .3-.7%

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Mrs. BWF September 6, 2011 at 4:12 pm

I never said it is JUST for previous c-section (I actually made it very clear throughout that is was not b/c I think that’s important that there are many other factors leading to uterine rupture, not just previous cesareans), but it IS part of these studies. Thank you for your thoughts! Check back for the post on just VBAC’s and uterine rupture. :)

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Christine September 6, 2011 at 4:56 pm

Well, I think it is misleading, you refer to VBAC several times in your post – as your heading picture, as your lead in, as your conclusion, and even make it sound like all VBAC ruptures are just a part of the .07%

Deb September 6, 2011 at 3:00 pm

I have never actually seen a uterine rupture in the 30 years I have practised but I do know of one attended by a friend (classical CS incision). So I do know they are rare, as I must have been at or around a few thousand births and have seen most things that happen in childbirth. I have suspected dehisience a few times though (postpartum pain over and above, slight shock, all of which settles). I assume this heals by itself okay.

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Elena March 21, 2013 at 6:10 pm

Shortly after I had my HBAC, a woman in the ICAN group, with a doula in attendence, at at hospital, suffered a uterine rupture, her baby did not make it. It was very upsetting for us all. It is possible, there is a chance, albiet small.

Women just need to be informed and make their own CHOICE not the practioner, not the spouse. Life is NOT risk free.

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sara September 6, 2011 at 3:02 pm

HI
I had a c section in 2006 then a VBAC in 2009 which I delivered at 32 weeks. Does this make mt risk any different the 3rd time vs the 1st Vbac since I delivered a preemie not a full term bigger baby? Are contraction all the same

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Annie September 6, 2011 at 7:21 pm

Thank you so much for your information. This is so valuable.

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Katharine Brown September 6, 2011 at 10:16 pm

Thank you so much for this information! I haven’t seen any summarized information this succinct since I read “The Silent Knife”. Also, I thought you covered your bases well since you mentioned (about 10 times) that this was a total percentage for ALL births. As a c-section momma about to have her first VBAC, I didn’t feel misled at all. Looking forward to your VBAC post and keep up the excellent work <3

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Mrs. BWF September 7, 2011 at 12:21 am

Thank you Katharine!

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Jaime September 7, 2011 at 12:24 pm

Katharine, I would like to hear how things go for you. I am due in late January and plan to have a VBAC. If you would email me or post a comment I would appreciate it.

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Kirsten September 7, 2011 at 12:02 am

I found it very frustrating to find out true figures differentiating between dihescence and a “proper” rupture when researching stats for a VBAC attempt after a classical ceasearean (my 2nd child was a 33wker with severe IUGR hence the CC). They are so very different, with such very different likelihood of outcomes.
This is my first visit to your blog – I’m enjoying looking around :)

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Mrs. BWF September 7, 2011 at 12:21 am

Glad you found your way here!

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runthegamut March 10, 2013 at 1:13 pm

If you still need more research, check out specialscars.org where there are stats and stories about scars other than low transverse. My own story of VBAC after preterm classical is among them.

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Rosie March 21, 2013 at 10:19 pm

Kirsten, you can find support at specialscars.org!! Hugs, mama!!

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Elyse September 7, 2011 at 8:15 am

I think this blog is (unintentionally) misleading. At the end you state…

“If you want to have a VBAC, find a care provider (midwife or OB) that is competent and supportive. Show them the research, talk about how to reduce the risk (even though small) of uterine rupture for you and birth your baby without fear!”

This first indicates that this post is targeted towards mamas interested in a VBAC, not pregnant women in general worried about uterine rupture (I doubt there are many women with an unscarred uterus worried about uterine rupture). Stating that the ‘low’ rate of uterine rupture includes VBACs and all uterine scars erroneously implies that the rates of rupture are low for women with uterine scars as well. It is important to point at that in the studies cited in the review article that focus on TOLAC, the rates of uterine rupture with a VBAC range from 0.5% to 2.4% depending on the study. This is significantly higher than the rates for the rest of the population.

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Mrs. BWF September 7, 2011 at 8:57 am

I understand what you are saying. I do not feel it is misleading as I made it clear what the statistics include. Also, it does give encouragement to VBAC mothers. Having all previous cesareans AND all other scarring and traumas of the uterus lumped together and the rate is still only .07% is…well, encouraging!

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Sarah September 8, 2011 at 8:49 pm

I am foursquare in favor of women seeing VBAC. However, the 0.07% includes the majority of women who have no scarring whatsoever on their uteri. The rate for any scarring is higher.

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Mrs. BWF September 8, 2011 at 11:14 pm

And I never said otherwise. :)

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RC February 24, 2013 at 8:53 pm

I do not find it misleading at all – I think it is made clear that all types of uterine trauma are included, not just former C-sections and VBACS. I am scheduled to have a Da Vinci robotic myomectomy next month (fibroid is in upper muscle wall of my uterus). I am very concerned about getting pregnant following the surgery and the risk of uterine rupture that could come with it. My doc says to wait six months before trying, but that no matter how long I wait rupture is still a risk. Does anyone have any specific info about this or gone through a similiar experience. I would have a scheduled C section, not attempt VBAC.

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Rosie March 21, 2013 at 10:25 pm

I know there are mamas who have vbac’d with myoectomy scars. Mollie Ringwald (sp?!) is one of them. There are many women who have non low transverse uterine scars that vbac and I am one of them! I have a J scar (low transverse incision tore to a J by a few inches into my upper right uterine segment on a “paper thin” uterus during emergency section when my son was pulled out double footling breech after turning completely transverse. I had chronic ployhydramnios and had my waters broken on my back with baby’s head not engaged at 10 cm and 100% effaced. I vbac’d on that J scar almost 11 mths ago on the 29th when I was told it couldn’t and shouldn’t happen. There is hope for you, mama!! Check out specialscars.org!! {{Hugs!!}}

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Tracey Pera September 8, 2011 at 11:01 pm

Thanks for your GREAT information. We can trust the Truth, and I am here to say this is TRUE.
I have had 3 Caesarean and 2 home births. I am the proud mama of five beautiful children. ALL ADULTS NOW, so we lived through all the ‘trauma’ and ‘scare tactics’ the medical world uses.
Girls, Dads, just learn the facts and trust God to help you birth well.
It can be done, I did it, and I am no ‘superwoman’.
I had a great Chiropractor who started ‘teaching me’ the Truth, I am so glad he mentored me in the facts of birth.

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Pam September 9, 2011 at 8:53 am

I’ve had 3 VBACs and have been a strong advocate of VBAC rights since my cesarean 9 years ago. I have researched the risks of VBAC and RCS, including uterine rupture, extensively. The Medscape article you linked to has been my favorite resource for rupture information for many years. It is thorough, accurate, and about as complete as you can find. It is absolutely true that the *overall* risk of uterine rupture for all birthing women is 0.07%, and I do realize you said over and over again that the number was for everyone. However, I have seen this reposted at least five times by VBAC advocates who read it and believed they’d found a new source saying the risk of rupture in VBAC has been vastly overstated by previous studies. When I’ve seen your article re-posted in that way, I have posted the following:

“Though this is discussed in the comments after the article, it’s really important to note that the 0.07% rupture rate is for ALL women, not just VBAC moms. Having a uterine scar still dramatically raises risk of rupture. If you go to the emedicine article the blogger is talking about, they specifically address how a woman with a previous c-section has a twelve times greater risk of rupture in future pregnancies even if she does NOT labor and chooses another c-section. While this author is standing by how she wrote this article, I believe it is easy for readers to misinterpret and think the rupture rate for VBACs has been vastly overstated by other sources. It has not.”

I don’t think it was your intention to be misleading in any way, but I can tell you from my years in the VBAC community that while rupture risk is often misunderstood and overstated by the medical community, it is also often misunderstood and understated by the birth advocacy community. Neither of those is helpful for women trying to make informed decisions. Again, let me be clear that I don’t think you are trying to be intentionally misleading, but even in the comments here it seems some VBAC moms believe their personal risk of rupture is in the 0.07% range and that simply is not the case.

I’m truly not trying to be argumentative here, I just wanted to point out that, yes, there are many people who are misinterpreting this post. That doesn’t make you wrong, but it definitely suggests more education and discussion is needed! I’ll look forward to your post on VBAC risks.

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Mrs. BWF September 9, 2011 at 4:34 pm

*Edited to add: While I emphasized this many times throughout the post, it has been brought to my attention that others are sharing this as a VBAC only post/percentage. I want to clarify that .07% is for all pregnant women, including no previous scarring, scarred from any trauma, VBAC and anomalies (.012 when only non scarred and .07 with all). VBAC rupture rate is closer to .3-.5%. Still very small, but higher when isolated to just VBAC’s. (I am researching this and will do a post on it soon).

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LAMR September 9, 2011 at 1:12 pm

love it I’m gonna spread far and wide. I think women need to take back their reproductive health especially in birth.

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sigrid September 9, 2011 at 1:53 pm

When I was 28 weeks pregnant with my second baby and saw my OB for the first time (instead of just a nurse practitioner), I told her I wanted to VBAC. She adamantly insisted that my rupture risk was 6%! Good think I knew better! She used all sorts of fear tactics to try to manipulate me into a RCS. I fired her practice and had an intervention-free hospital birth a few months later with a CNM. :)

But seriously…. SIX PERCENT??? What the heck?

Thanks for the info… good stuff here!

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Rosie March 21, 2013 at 10:35 pm

I was told by a covering OB (while my CNM was out of the room catching another baby) that my risk (in THAT MOMENT) of rupturing was 20%!! I waited for my contraction to end and then replid, “No it’s not, it’s actually 1.9% and of that 1.9%, 6% are catastrophic” (New England Journal of Medicine, Landon Study (we call it the Landon study. You can find it at specialscars.org) and he didn’t like that one bit. He then sputtered back, “WELL, I have delivered THOUSANDS of babies.” blah blah blah…and then proceeded to continue to bully and belittle me. I said, “I appreciate that. Thank you.” (HA! It was all I could think of?!) and then went into another contraction and he just backed up and watched me birth my baby. (My midwife came back). Anyway…I don’t know where they are getting these stats? One of my special scars sisters said she thinks she saw that 20% on yahoo or something. I wish I would have known that I could have been like, “did you get that from yahoo?!” lol (but actually it’s not funny, the fear mongering is rediculous!)

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Murasaki September 10, 2011 at 3:06 am

0.07% overall, 0.03-5 for scarred means that rupture CAN happen to non scarred women and I find it incredible that that fact is totally glossed over – particularly the relation between inductions, beetle birthing (birthing on back), coached pushing, instrumental birth and UR.

I’d like to see the stats on UR for non scarred women and whether or not they were induced – and whether or not induction raises the risk of a UR. I have no idea where but I’m sure I remember reading once that an induction on a 3rd or greater birth carries the same risk of UR as a VBA1C. Cant back that up though.

I’d also like to know the degrees of the UR, presumably the figures count minor ruptures (so minor the birth goes ahead as normal) and the degree of catastrophic outcomes – hysterectomy, maternal death, infant injury and infant death. Not every UR results in immediate fetal death as we are led to believe – yeah?

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Taylor September 11, 2011 at 7:41 pm

I am very determined to have a VBAC this time. I have had a wonderful pregnancy without any complications (unlike my first pregnancy where I had placenta and marginal vasa previa- with a c-section and a very healthy perfect baby girl). I really feel a sense of- perhaps not negativity, but doubt from others when I say that I am opting NOT to have a section again. I want more than anything to deliver my son naturally. I am not afraid of anything EXCEPT the possibility of being presurred into an unneccessary and quite debilitating surgery. I have hired a doula and talked with my doctor extensively, but it seems like the she’s always pulling out the “just in case” this and that. Please let me know what you think. I need encouragement right now- I’m 4 weeks away.

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jessica September 12, 2011 at 2:30 pm

I just found out I am pregnant with my 3rd . My first was 9lbs and after 18 hours of labor , his heart rate began to drop and so did mine . They did a c-section which is what needed to be done , but still heart breaking. With my 2nd , I begged for a v back . My OB felt like it would be too risky , so I had a scheduled c section 2 weeks before he was due , and afterwards suffered a brain hemmorage that I am not convinced was cause by the spinal or the surgery . This go around , I really do not want to be cut , but after what happened the last time , my doctor really thinks it is for the best and refuses to even think about natural birth . I am a firm believer that babies come when they are ready . I want to not have the c section at all , but especially not before the due date . How can I avoid all this . I am seen as being high risk . Who’d want to take that risk with me ? My husband doesn’t want me getting another spinal , and wants me to be knocked out . I do not want to miss the birth of my last child . I feel as though I have lost all control over what happens to my body . I feel like a total tool who has no say so in how it is used or treated . I am totally lost for ideas and options here

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Kathleen Neely August 28, 2012 at 10:58 pm

find another Doctor, this one does not care about you and your desires, Find a different OB or midwife that will help you make your own decisions.

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Claire Bushell September 13, 2011 at 6:54 am

Anyone know of the rupture rates for induced labours?

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Elizabeth Hawthorne September 26, 2011 at 7:17 am

I’m curious about this too. I was induced with my 2nd baby (vaginal delivery for the first) and my uterus ruptured during the birth. I believe it was the syntocinon that caused my uterus to contract too quicky, causing the rupture. My daughter was born without a heart beat but she survived. They didn’t discover the rupture until 9 hours after the birth! I went in for surgery to ‘repair the hole’ and come out minus one uterus and most of my cervix.

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nicole September 13, 2011 at 10:35 am

I have a sweet VBAC baby. She was born 3 years after a Csection for failure to progress. Greatest thing I ever did! The docs all wanted to talk about this risk, but that was why I had docs and a hospital. If it happened they were ready to handle it! I was even given pitocin during this labor and had no problem! Love this article!

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Angel October 13, 2011 at 12:32 am

I was the 1%…
6 years a go I gave birth to my beautiful son in the water with a mid wife after a long 24 hours labor. All I wanted, I was so happy! Everything went well!
I had a lot of miscariages true my life and was worry about it. My Ob find out I had a uterus septum and that what was causing my miscariges to his point of view. So I decided to undergo surgery to remove my septum. After the surgery he mention to me only ONCE really casually that I was a 1% risk of a uterine ruptured and I could have a plan csection or try a vaginal birth but could may be be a really SMALLl risk. This was never mention to me again so I taught I was normal and at no risk! I did had a miscarige again after 1 year of the surgery. So we tried again and yes I was pregnant! We were so happy and I was so on it…with all my vitamins, eating the best food and doing my yoga…she was perfect! After 20 weeks of pregnancy I had to change Dr, due to insurance, so I did. For the last 21 weeks I taught the new doctors had my previous records because I signed a release to find out after a nightmare they did not. I kept telling them my story of previous surgery and they all treated me “normal” 5min visit in and out…no worries! I kept asking questions and they said i was normal! They even wanted to induce me at 41 weeks and I did not want to. So on September 14 2011 I lost my beautiful daughter named Eva, she was perfect! I almost lost my life. Thank god I had my midwife at home with me during the first hour of labor, not even full labor…she kind of saved my life! I was only 4cm and not even having really strong contraction, she was monitoring the babies heart before going to the hospital…well it stop! I ran to the hospital and it took them 4 hours to find out what as had happen! My uterus had ruptured and the placenta was out of the uterus. My baby Eva was no longer going to live with us, our dream flew away. I never taught this would happen, I was a healthy woman and I had a healthy baby girl. There was no sign in early labor of the rupture, no bleeding, the blood pressure was good…just Eva’s heart! I had some angel over to protect me some how…I still have my uterus all stitch up and I pray that someday I can have another baby…with a c section…
For now I live in the present moment and try to heal my soul, body and spirit! I am grieving of the worst thing a mother can live, the lost of a dream…
Thanks for reading and please always make tones of research on surgeries offer to you, doctors not listening, keep asking questions and have second opinions, change doctor when you are a number to them, meet midwifes and always follow your heart.
Don’t take chances for the love of yourself and your baby.
I cant go back I can only live in the now…

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Mrs. BWF October 13, 2011 at 12:41 am

Angel, thank you for taking the time to share your story and about your little girl, Eva. I am so so sorry for your loss mama.

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Heidi Freitas October 26, 2011 at 5:27 pm

**What lowers risk? Previous vaginal births and more time to heal between a cesarean and subsequent pregnancies.

So what is that time frame? I’ve had 3 pregnancies, 1st vaginally (almost 11 years ago), 2nd c-section (8 1/2 years ago) because of induction with FTP and the 3rd (18 months ago) was an attempted vbac with repeat c-section for FTP. I am planning on getting prego again in the next few months and want to do a home birth so that my Dr.’s fears aren’t pushed on me.

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Tina November 3, 2011 at 5:42 pm

Hi Heidi
Based on the stats, the minimum recommended time is 18 months between pregnancies, so as you’re already past that…… good luck TTC!

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Emma October 27, 2011 at 2:29 am

I had an emergency c-section and then attempted VBAC with my second pregnancy (5 1/2 years later). I didn’t manage – baby was in distress – but in the process of that emergency c-section, the doctors ripped my uterus. I was in surgery for a long time. Afterwards, I was told that VBAC was not a possibility for subsequent pregnancies. Felt a bit ironic, to be honest.

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Rosie March 21, 2013 at 10:48 pm

There is support and hope for you, mama!! Please go to specialscars.org!! {{hugs!!}} My uterus was ripped (to J by a few inches into the upper right segment of my “paper thin” uterus) during the emergency section of my third son. I was able to vbac w/ that J scar. There is hope!!

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Kimrose October 27, 2011 at 11:10 am

I understand that this piece isn’t specific to VBAC’s, but wanted to share an important piece of information in case any women reading this might fall into the same category as me. I am part of a Facebook group called “Special Scars, Special Women” – we have all had cesareans that left us with “not the typical” scars on our uterus, meaning the low transverse. There are classicals, T’s, inverted T’s and J’s and I’m sure a few variations. What makes this matter is that typically we are COMPLETELY DENIED the option of a VBAC – and seen as a BIG uterine rupture risk. That said, I’d say the MAJORITY of our ever-growing group has fought for or is fighting for VBAC’s. It’s a *very* informed, educated decision – and the *truth* is that even in our numbers, the rupture rate is STILL LOW/VERY LOW! The struggle is very uphill for most of us – but we arm ourselves with the true numbers – and are working on getting accurate numbers/research done via our stories since we’re an organized group sharing these scars. The Landon study is the one I’m thinking of off-hand w/info. re special scars. If there are ANY women reading this that have a “special scar” – please find us on Facebook and ask to join the group – it is an AMAZING source of support and information – and MANY, MANY SUCCESS stories – in the time I’ve been there, we have had almost-all succesful VBAC’s ;) and I can’t think of a single rupture – I know I’m not giving numbers here, but just for what it’s worth. My own story is natural labor in 2005 w/breech discovered during pushing – told that baby was in trouble/had to come out NOW – no option or discussion of vaginal breech delivery – I had no clue that was the reason for the section and was trying to “not push” as they put me under ;( I spent a good deal of my second pregnancy stressed and researching and finding and losing and finding a new provider…and in the end delivered alone/without chosen provider at a hospital w/a VBAC Ban. I fought right through labor and it wasn’t perfect, but I was still thrilled and it was still healing. My biggest point is that NO WOMAN should have to FIGHT through labor. Absolultely ridiculous and horrible. At any rate – my point was just to extend the support of the group to any “special scar” women…we are typically made to feel so “rare” and told there is *NO WAY* we can have vaginal births in the future…and many, many of us are proving the feared-outcomes wrong every day.

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Mrs. BWF October 27, 2011 at 11:37 am

Thank you Kimrose! I’m still waiting for my invite to your group! ;)

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Rosie March 21, 2013 at 10:51 pm

HI Kimrose!! {{waving!!}} :)) Yes, actually “fighting” as I did w/ that covering OB *during* pushing is absolutely rediculous!!! I shutter to think of a mama under his care that isn’t as researched or “ready” to “fight” as I was…he was very intimidating but I stuck to my guns. It shoudln’t have to be that way!!!! :(

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Shelly November 14, 2011 at 6:01 pm

Thank you for this, Mrs. BWF. I attempted a VBA2C on June 14, 2011. My first CS was necessary (severe Pre-e,that was repeatedly ignored by my midwife, delivered at 33 weeks after 36 hours of hard, induced, unmedicated labor (stuck at 4 for about 33 1/2 hours of it, so I was labeled FTP), my son was a RCS due to a very impatient OB, didn’t even have a chance to go into labor (I should have fired her.) I went into labor with my attempted VBAC baby at exactly 41 weeks, after 50 hours and 2 minutes of labor, also my water broke at 2cm (literally as soon as the epidural hit the catheter my water broke, all over my poor sweet nurse) and my Peri then started Pit, wasn’t too happy about that but didn’t argue (again, I spent a good deal of time at 4) but I dilated from 4 to ready to push in less than 3 hours this time! After just over 2 hours of pushing she still would not descend due to being OP (started at 0 station and stayed at 0 station), so I had a repeat, but it was amazing to come so close to pushing her out! My OB has already ok’d me for a VBA3C when the time comes, I can’t wait!

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Shelly November 14, 2011 at 6:36 pm

Angel my heart breaks for you. I had 7 1/2 months with my Kylee Bean, but unless you have a lifetime with them, it’s just not enough :-(

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Sarah January 26, 2012 at 12:01 pm

I had a CS with my first who was breech, a VBAC with my second although it was long pushing (he was 9 lbs 5 oz), and a RCS with my third because I lived somewhere where I couldn’t have a VBAC. Now I’m pregnant with my fourth and am seriously considering another VBAC. My doc (first time with him) recommends RCS since I’ve had 2 previous CS but says the choice is up to me…if I go with TOLAC he wants me in the hospital the whole time and constant monitoring (not a big deal to me). It will be 3 years from my last CS. Also I don’t know if it makes any difference but my uterus made it through my last VBAC with pitosin (slow progression). I always get concerned when I hear the stories of uterine rupture actually ocurring (I know someone it happened to). Any advice? Thanks for this post….it’s more reassuring.

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Melissa February 20, 2012 at 2:13 pm

I am one of the .07% that had a uterine rupture while delivering my baby in March 2011. We were very fortunate to have both survived, and my little boy is doing great. He just came 7 weeks early.
This was my second child after a lateral incision c-section because of fibroid tumors covering my cervix. My doctor had already placed concerns about me going into labor with my second child and was planning to deliver at about 36 weeks just to avoid any catastrophe. Needless to say, I am done having children.

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Lori Weatherly March 2, 2012 at 10:31 pm

Almost 7 years ago, I gave birth to a beautiful baby boy 8 lbs 14 oz. I had a uterine rupture causing many complications and his death, along with life changing injuries to me that were associated with this. I had one child before, and he was a vaginal delivery. I had never heard the term uterine rupture before that fateful, awful day that changed our lives forever. I wrote my story in a book “Facets of Life; What I Didn’t Expect When I was Expecting” last year and have been trying to help many families suffering such loss. I looked all over for a book written by a woman who suffered a UR and survived, with injuries as mine and I could not find one. So I wrote my own. I think it is really important to educate expecting mamas on UR’s. If you want more info on my book, you can visit loricweatherly.com ~ I hope and pray babies lives can be saved, and the numbers of families burying their babies will decrease. Please note again, I was NOT a VBAC and was completely unaware this was something that could happen, but it did.

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Stephanie May 25, 2012 at 1:00 am

Thank you for sharing, I needed to read this again!

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Larissa June 14, 2012 at 7:10 pm

Such a GREAT post! Getting correct information like this is essential to every pregnant woman. Its such a shame to see and hear of women who dont know half of any of this! I am planning my hba2c…im due in just 2weeks! Ive added the link to my blog if anyones interested :)

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Andrea August 7, 2012 at 9:21 pm

I think its great that you are spreading awareness about uterine rupture. It’s something that a lot of women don’t worry about because its so rare. I attempted a VBAC in March and I did a ton of research. I did end up having a complete uterine rupture. Didn’t expect it but I knew so much about it. It’s extremely rare, but it does happen. And when it does happen, it changes your life!

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Michelle August 27, 2012 at 7:17 am

I have enjoyed reading thru the posts. I had a c-section in 1999 due to fetal distress. Healthy boy:) Became pregnant in 2002. Tried a vbac. Pushed 2 hrs then doctor tried the vacuum. My daughter was mot coming out. So they did an emergency section. Upon discovery I had a 3mm dehisinse. Healthy baby.
I was warned by my obstetrician against another pregnancy in fear of a uterine rupture.
Fast forward ten years. I would love to have another. And it’s only thru sites such as this and many years of research that I am learning of the massive difference between a rupture and dihisince. I have an appointment with another obstetrician soon to discuss all this.
My point. It is very hard to know what can happen during labor. Hard to follow emotions because I would love to have another. Will see what the second opinion brings.
Thanks for your stories. And to the mom’s who lost your little ones my heart goes out to you. But thank God you are alive to share your story.

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Shannon September 4, 2012 at 1:03 am

I am one of the 0.012%. You never think it could happen to you until it does. The day you give birth to your baby is supposed to be the best day of your life. Mine was the worst… the worst week of my life. My uterus ruptured & I was rushed to the O.R. for an emergency csection where my baby was pulled out limp, not breathing, no detectable pulse, with an Apgar score of 0. Most babies die. But mine was resuscitated, put on a ventilator, and immediately put in ice to bring his body temperature down to prevent any further brain damage from the loss of oxygen. He was kept cold (33 degrees Celcius) for 3 days, then rewarmed when he began having seizures. We thought he had permanent brain damage. But then things turned around for him. He would suck on a pacifier, drink breastmilk from a bottle, then nurse… & his MRI came back perfect… no brain damage. I am so lucky that my now 6 month old baby is PERFECT. But I also know of many women who lost their babies bc of uterine rupture. The chance may be low, but it does happen.

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Precila December 24, 2012 at 12:39 am

I have had one C-Section 21 years ago and subsequently have had 6 VBACs. From the C-Section to the next birth was a year and half later. My husband and I then waited 5 years to have baby #3 and the next 3 babies are 2 years apart. Baby #6 to baby #7 there is a 4 year gap. We are now expecting baby #8 after 4 years since our last baby. With that being said my doctor says that I should have another C-Section because I have had a C-Sectional ready and is concerned that I can suffer a uterine rapture. I don’t see how this makes any sense. He says that its because of all the pregnancies I have had since the C-Section, that all my other pregnancies may have caused my C-Section scar to possibly have gotten weak. I would love your opinion on my situation. I forgot to mention I had my C-Section due to fetal distress(she had her umbilical cord wrapped around her neck and also her waist) . My other babies have all been fine and healthy before and after their births. Thank you

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KWills March 9, 2013 at 11:12 pm

Along these lines:has anyone come across info regarding uterine rupture when a single closure vs a double closure has been used? I’m 33weeks and going for a home birth VBAC, but was just informed by my midwife that I was given a single closure during my c section. I’ve tried researching, but information is quite limited. I did find an article by Ina May that was interesting because she wasn’t exactly in favor of a VBAC with a single closure, unless under (listed) certain criteria. I just want to make the best informed choice for my baby and myself, so if anyone can share any insight I’d appreciate it.
Thanks in advance and thank you BWF for being such a great resource! I have recommended your FB page and blog to so many people!

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Jess May 1, 2013 at 3:01 pm

Hi there, first I would like to say what a beautiful site this is. Here is my situation, I am 30 years old, and a mother to 5 children, all born via c section ( 03, 05, 08, 09 & 11) At my last section, almost 2 years ago the stitches from my previous section (2009) were still on my uterus. My ob said she would never tell me I cannot have more, but now I have found myself pregnant again, and I can not find really any information on the risks of multiple c sections, and I cannot find any information about why my stitches would have still been intact after almost 2 years. Now thus time I am very worried about the risks of rupture after so many sections. Does anyone out there have any experience or advice? Thank you!

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Heather October 8, 2013 at 10:58 pm

Hello, thank you for such wonderful information. Wondering if you could help me out. I have had 3 c-sections (2002, 2006) and most recently Aug 2013. When my ob came to see me, she told me that i am not to have any more babies. She said that my uterus is worn so thin that during the last c-section she could see the membranes (nothing had ruptured) but said that it was very, very thin. She described it like saran wrap. What did she mean? Is this what uterine dehiscence is due to my c-section. I was really sad and upset from what she said…we would love to have another child. Can someone please share their thoughts. I am scared, but feel like the benefits out weigh the risks.

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Mel July 18, 2014 at 6:54 pm

I have 4 children, my first two were relievers naturally and my second two by csection because they were breech. I was recently approved at 20 weeks for a vba2c, then today I was told that it was too risky, and get this that my odds were 30% chance of uterine rupture!! I have never heard these odds or read them in any articles I’ve read! The timeline in between my last section will be 17 months, which is not ideal, i know. But 30% was shocking to hear, did my OB just make this up ?! Why would she do that? I am getting a second opinion. But reading some of these stories, .07 percent or 30% I’m not sure I want to risk my babies life on fulfilling my desire for a natural birth.

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Mrs. BWF September 6, 2011 at 5:19 pm

All VBAC ruptures ARE part of the .07%. I am not misleading. I clearly state it DOES include ALL previous cesarean section related ruptures PLUS other uteri scarring/trauma. I think you are looking for an issue that isn’t here mama.

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Joy September 8, 2011 at 10:01 pm

I agree with Mrs. BWF. I think y’all are looking for an argument that isn’t there. Why can’t we all just get along?! And honestly, who cares if she mentions VBAC? Most women following this blog and FB are women desiring encouragement and hope for their VBACs. Let us all just calm down and act like adults, mmkay?

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christie September 8, 2011 at 11:52 pm

i agree that person was being argumentative for the sake of it, i am going to be attempting a VBAC in a hospital and have been arming myself with the facts and i was not in any way mislead, everything i have read says that the risk or rupture/dehiscence is only .02% higher after a previous c section which makes it .07% which is exactly what this says, not sure where the problem was but hey, i just wanted to say that i like to say it the other way around so in 99.93% of births its not going to happen!

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Mrs. BWF September 9, 2011 at 7:51 am

It is usually said to be .2-.5 percent, not.05. I am researching it now. You are right though. 99.95+% of the time in VBAC moms, it does not happen!

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Christine September 11, 2011 at 8:48 pm

No, your rupture risk is about .7% (7 in 1000) not .07% (7 in 10,000) which is the rate for all women, which yes, includes scarred women but also a much higher number of unscarred women.

Mrs. BFW, thank you for the clarification paragraph and for changing the picture.

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Amy October 5, 2011 at 11:59 am

I like your way of thinking, too!!

I clearly understand that pregnant mothers as a whole risk .07, while specifically pregnant mothers attempting to VBAC risk somewhere around .5. It’s higher, yes, but not a risk associated with only those of us attempting to VBAC. That is encouraging to me. It means it can happen to anyone, so if I’m going to be all stressed out about it, then we ALL should. Or take it in the reverse… Knowing that it’s a risk of any pregnancy is enough for me. I don’t need to prove and defend my choice to VBAC any more than one who is pursuing a “normal” vaginal birth.

Thanks :)

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Mrs. BWF September 12, 2011 at 9:58 am

It’s closer to .5% for VBAC moms. I changed the picture because the owner of the picture does not want it used anywhere. You’re welcome! :)

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TNHSW December 16, 2011 at 1:34 pm

This is a great article. I’m just going to restate the numbers one more time because of so much confusion.
Every pregnant woman in the world: 1 per 1536 (0.07%)
Preg women w/unscarred uterus “industrialized”: 1 per 8,434 (0.013%)
Preg women w/unscarred uterus “developing”: 1 per 920 (0.11%)
(w/1 c/s) Elective repeat cesarean delivery: 1 per 623 (0.16%)
(w/1 c/s)TOL History previous successful VBAC: 1 per 581 (0.17%)
(w/1 c/s)TOL No previous successful VBAC: 1 per 125 (0.80%)
(w/1 c/s) Failed VBAC or repeat c/s in labor:1 per 73 (1.4%)
(w/1 c/s)TOL with interdelivery interval ≤2 years: 1 per 41 (2.8%)
Fetal macrosomia >4000g baby 8.8lb+ : 1 per 39 (2.6%)

http://emedicine.medscape.com/article/275854-overview

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Amanda L May 25, 2012 at 1:45 pm

Thanks TNHSW for listing the stats. I don’t agree with posting the stat for all women because it’s meaningless. You know if you had a c-section or not, so you either have a very low risk or a higher risk. The 0.07% is much too high if you have no uterine scar, and much too low if you do. This is just bad science… sorry :( I’m speaking as a scientist and a mom who had a T-incision and I will be attempting a VBAC.

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