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Hyperemesis Gravidarum – {More than Morning Sickness}

Hyperemesis Gravidarum – {More than Morning Sickness}

With the recent news that the beloved Duchess Kate was hospitalized recently in relation to HG (Hyperemesis Gravidarum), I saw both an out pouring of love, and more often, ridicule. First – why on earth would we malign a soon-to-be mother for getting medical help? That in itself is mind boggling. Second – the absolute disregard of any information given on the subject was astounding to me. Having suffered from HG myself, I was sadly not surprised to see the general public basically laugh at this poor woman and tell her “suck it up”.

I wanted to help get the word out. HG has been hidden for years and is not well understood in the medical community. But real women – from myself to a future Queen of England – suffer from this horrific condition. Sharing my story is not always easy, as people are fast to dismiss or believe that I am exaggerating – but here it is.

My husband and I were over the moon about finally conceiving our first child. We immediately began to talk names and look at baby clothes. Our families were excited, our friends were overjoyed. Everything was rosy. Around 7 weeks I started to vomit a bit and have a lot of nausea. Par for the course in early pregnancy. We went to our first appointment and had an ultrasound (I was having pain that suggested an ectopic). Everything seemed normal and average.

Then a week later I began to vomit more…and more…and more. Within days of this new trend I was vomiting more than 15 times a day, and dry heaving constantly. The nausea was so horrible that literally just turning my head could trigger heaving. Nothing stayed down – no water, Gatorade, crackers, juice, rice, ginger, NOTHING. I began to feel weak and could not stand long enough to shower.

I called in sick to work several days in a row and got co-workers to cover some shifts. I called the OB office (where I was receiving care until we got insurance to cover our midwife) and was told that “as long as I could keep down a cup of water a day, I was okay.” They also gave me phenergan over the phone though I informed them that it did not work for me (from previous experience). They would not prescribe anything else in place of phenergan.

I spoke to family and friends and was assured that this was normal and a sign of a healthy pregnancy. No one seemed to understand that I was not exaggerating my vomiting episodes. My husband helped as much as he could, but he had to work since I was missing work.

My job (which I loved and had just started a few months prior) began to comment on how much I was missing, and that when I did drag myself to work that I was “in the bathroom too much”. There were other pregnant women in my area after all, and they were fine. After about three weeks of this they suggested I take FMLA (family medical leave – unpaid) so that I did not lose my job. I was given 30 days in which to “get better and rest”.

Only a few days after this I began to vomit blood. My esophagus was so torn and ragged from the acid (which by this point was all I was vomiting up) that it was like a big wound. I decided that this was NOT “normal” and that I had to go to the emergency room. My husband came home and we loaded up to go downtown.

Hours later, I was seen. They let a student paramedic do my IVs…he blew three veins before they got someone experienced in my cubicle. The nurses ignored my husband and myself, and I sat with empty IV bags for long periods (I ended up needing 3 1/2 bags). I was informed that my blood work showed I was almost at organ failure level, especially my potassium. No one offered to check on my baby. We were not admitted, even after 5 hours in our little ER bed. I was told I should have gone to the Women’s hospital instead.

The one good thing to come out of the trip was the discovery of Zofran. The Zofran did not totally cut the nausea but it made it much more livable and cut down my vomiting to a few times a day, though it was a long time before I could force myself to eat much. The mental damage of so much vomiting was hard to get past. I did not start to “mend” until about 24 weeks, and continued to need the Zofran all the way through pregnancy.

All said and done – I lost over 30lbs in about as many days. I was required to take Zofran every four hours around the clock or I would need a home IV line (I have a huge fear of needles, so I wanted to avoid that if I could). I lost my job, since after the 30 days I was not “better” and my midwife wrote a list of work restrictions that the company could not accommodate. We had to move in with my mother. My son was born “late pre-term” at 37 weeks. Premature birth is a risk of HG. My son was a little peanut as well.

To this day I do not think my family understands what I went through. I don’t think they understand my fears for future pregnancies. But talking to other HG moms, I am not alone. And I was lucky – women die of HG, women lose babies. And almost every HG mom will tell you – you start to lose yourself in the midst of the sickness. You feel alone, so alone. You worry you are killing your baby, and you blame yourself every day.

I was able to speak with other mothers in the BWF Fans Support group about how HG effected their lives.

“After my daughter was born and my midwife looked at my placenta, it was thoroughly calcified and only a very small part of it was providing nutrition to my baby. We are very lucky to have her here with us. HG is emotionally and physically wearing, and I would wish it on no one. I just wish people were more educated about it rather than just tell you to suck it up and deal with morning sickness. Its so much more than that.” – Alyssa

“I was unable to shower by myself, did not have the energy to wash my own hair or body. I had to quit one of my jobs at just 10 weeks pregnant with my son. My husband had to continue working to support us but he felt terrible leaving me home alone every day. I sank further and further into depression and became very anxious that I was starving my baby and that it and I would not live to see the day I held the baby in my arms.” – Jade

“Both my pregnancies I had HG. I was barely able to care for myself or get out of bed most of the pregnancy. I waited 10 years between TTC my sons & stopped at 2, because I can’t care for my kids for 9 months at a time.” – Vee

“My HG nightmare began at 6 weeks. By 10 weeks I had to quit my job because I was in and out of hospital for IV hydration and vomiting blood. Some days I couldn’t even walk across the hall to the bathroom to vomit and I needed to sit on a chair in the shower because I would faint if I stood for more than a minute. By 15 weeks the strain became too much for my partner having to work full time while running our household and nursing me and we had to move in with my parents. People – some of them Doctors – told me mind over matter, take a walk, get some fresh air, have some ginger, eat a cracker. They told me if I really cared about my baby I would just drink some water and I was desperate to do so but knew if I did I would just vomit till my throat bled again. Formerly close friends accused me of being weak, selfish and melodramatic and stopped talking to me. Every day for the first two trimesters I cried wondering if my baby and I could possibly survive this. HG is not morning sickness – HG is a chronic, all consuming, life threatening, misunderstood illness that I would not wish on my worst enemy.” – Johanna

“I was hep-locked for weeks and went twice daily for IV meds and fluids. It is very debilitating. For the first several months I threw up constantly.” – Brittany

Another mother you may know who has suffered from HG is Jessica from The Leaky Boob who wrote a post “celebrating” her new common trait with the Duchess. She has written several posts speaking about her personal journey though HG.

A truly amazing resource (and one I did not find until after I had my son) is Help HER – a hyperemesis awareness and research group. They help fund a research project with UCLA into the genetics of HG. There are forums on this site dedicated to the women, fathers, and families who suffer this illness. Pages of testimony exist on their site, wanting to be heard. They even helped create a day on our calenders to recognize this illness – May 15th is HG Awareness Day.

This blog writer posted some time ago about the “ABCs of HG” – it moved me to tears.

This is NOT something you can ever understand until you have walked that mile. Morning sickness is not the same, and I don’t want to hear about how “bad” it was to vomit a couple times a day over a month or so. I don’t want to hear about only “being able to eat crackers”. I would have given my right hand to keep down crackers most days. These are things I am not supposed to admit in polite conversation – but HG is not a polite illness. It is callous and horrible and takes women and babies from our lives.

This is NOT morning sickness. This is not a pregnant woman being a drama queen or lazy. This is not something a few crackers before getting out of bed can fix. Or ginger. Or what ever else is in the normal bag of tricks for morning sickness – I tried them all. This is a truly debilitating illness in every possible way. I hope that next time the world hears of a mother suffering from HG their advice will not be “suck it up.”

***I have now been through another HG pregnancy, which you can read about here (from my husband’s perspective).

Bad or Good Advice…Delay Breastfeeding to Help Vaccine Effectiveness?

Bad or Good Advice…Delay Breastfeeding to Help Vaccine Effectiveness?

A friend shared this article with me from GreenMedInfo.Com. My jaw dropped. Literally.

“Vaccination proponents have suggested that breastfeeding should be delayed in order to prevent immune factors within breast milk from inactivating vaccine-associated antibody titer elevations and vaccine potency.” – GreenMedInfo Summary

This actually came from a study published in the Journal of Pediatric Infections & Diseases in 2010.

Let me see if I can understand this thinking. Do not give baby the best nutrients and antibodies possible so the ingredients/disease in the vaccines to be more ‘effective’.

From the study:

“INTERPRETATION: The lower immunogenicity and efficacy of rotavirus vaccines in poor developing countries could be explained, in part, by higher titers of IgA and neutralizing activity in breast milk consumed by their infants at the time of immunization that could effectively reduce the potency of the vaccine. Strategies to overcome this negative effect, such as delaying breast-feeding at the time of immunization, should be evaluated.”

How sick are they trying to make our babies?

That is Bad Advice. Let’s talk about Good Advice.

baby hand prints

Instead of taking away nature’s best way to nourish and protect our babies and injecting them with man made chemicals and diseases, let’s focus on what we can do to boost their immune system (with breastfeeding of course). This is not about if you choose to vaccinate or not, as I won’t judge either way, but what ALL of us can do to ensure the strong immune systems and health of our children either way.

Breastfeed…a given.

If you can not breastfeed, try to find donated milk. Eats on Feets and Human Milk 4 Human Babies are good resources.

Chiropractic care starting from birth (can find a good one here or here).

Healthy diet for mom.

Baby led weaning and healthy diet for infant/young baby/toddler.

Consider a good Omega oil for you when nursing and your child when they start solids.

Start researching now on alternative treatments (home0paths, oils, etc) to help along side any allopathic treatments.

Studies are not the ‘tell all, be all’ for parenting, health, birth or life. Common sense and education are much more reliable. Do what you feel is best for your little ones, but do so in an informed manner!

 

 

A 10‐Year Population‐Based Study of Uterine Rupture Shows Risks of VBAC to Mom and Baby are Low

A 10‐Year Population‐Based Study of Uterine Rupture Shows Risks of VBAC to Mom and Baby are Low

Obstetrics and Gynecology released this 10 year population based study of uterine rupture in October 2002.

Objective

To review the incidence, associated factors, methods of diagnosis, and maternal and perinatal morbidity and mortality associated with uterine rupture in one Canadian province.

Methods

Using a perinatal database, all cases of uterine rupture in the province of Nova Scotia for the 10‐year period 1988–1997 were identified and the maternal and perinatal mortality and morbidity reviewed in detail.

Results

Over the 10 years, there were 114,933 deliveries with 39 cases of uterine rupture: 18 complete and 21 incomplete (dehiscence).

Thirty‐six women had a previous cesarean delivery: 33 low transverse, two classic, one low vertical.

Of the 114,933 deliveries, 11,585 (10%) were in women with a previous cesarean delivery.

Uterine rupture in those undergoing a trial for vaginal delivery (4516) was complete rupture in 2.4 per 1000 and dehiscence in 2.4 per 1000.

There were no maternal deaths, and maternal morbidity was low in patients with dehiscence. In comparison, 44% of those with complete uterine rupture received blood transfusion (odds ratio 7.60, 95% confidence interval 1.14, 82.14, P = .025).

Two perinatal deaths were attributable to complete uterine rupture, one after previous cesarean delivery. Compared with dehiscence, infants born after uterine rupture had significantly lower 5‐minute Apgar scores (P < .001) and asphyxia, needing ventilation for more than 1 minute (P < .01).

Conclusion

In 92% of cases, uterine rupture was associated with previous cesarean delivery. Uterine dehiscence was associated with minimal maternal and perinatal morbidity. In contrast, complete uterine rupture was associated with significantly more maternal blood transfusion and neonatal asphyxia.

Summary

Out of 114,933 deliveries, there were 39 total ruptures (.o34%), with 36 of them having a previous cesarean. Complete ruptures counted for 18 of those (.016% chance of complete uterine rupture). No mother deaths.

2 infant deaths (2 0f 114,933 deliveries is a 0.0017%). One of the deaths the mother had a previous cesarean, one had no previous cesarean.

Uterine scar dehiscence is different than complete uterine rupture. Dehiscence is the separation of a preexisting scar that doesn’t disrupt 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.

 

Thank you Candice Young for the beautiful picture.

Thank you Emily Cicora for sharing the article.

Percentages calculated here.

For more info on uterine rupture rates and cesarean risks.

Other resources: Uterine Rupture in Pregnancy

 

Risk for Mother: Higher With Cesarean Birth?

Risk for Mother: Higher With Cesarean Birth?

I was reading this story and came across more information about cesarean sections. Natural birth advocates talk about the number of surgical births being too high, but what does that mean? Why do we care?

To quote from this article:

“C-section or caesarean section risks are roughly fewer than 1 in 2,500, significantly more than the one in 10,000 risks for vaginal birth.”

“About 36 women per 100,000 die while undergoing a Caesarean section, or C-section, compared with 9.2 deaths per 100,000 vaginal deliveries, according to a published study in the Journal of Obstetrics and Gynecology.”

Wait. That is from the Journal of Obstetrics and Gynecology? 9.2 to 36 is an 291.3% increase. That is a huge difference that even made me question the validity of such a claim. I am not a math whiz, but this seemed too high. I decided to dig a little further.

This article from AJOG (The American Journal of Obstetrics and Gynecology) collected data from 1.5 million deliveries between 2000 and 2006. They found the following:

“Ninety-five maternal deaths occurred in 1,461,270 pregnancies (6.5 per 100,000 pregnancies.) Leading causes of death were complications of preeclampsia, pulmonary thromboembolism, amniotic fluid embolism, obstetric hemorrhage, and cardiac disease. Only 1 death was seen from placenta accreta. Twenty-seven deaths (28%) were deemed preventable (17 by actions of health care personnel and 10 by actions of non-health care personnel). The rate of maternal death causally related to mode of delivery was 0.2 per 100,000 for vaginal birth and 2.2 per 100,0000 for cesarean delivery, suggesting that the number of annual deaths resulting causally from cesarean delivery in the United States is about 20.”

Well, that’s not 36 per 100,000! That is quite a jump though  from o.2 per 100,000 to 2.2 per 100,000 The numbers are smaller, but that is a 1000% increase/difference!

This Discussion on the issue (and study) by 6 M.D.’s revealed some interesting information. I will highlight a few points. Please see the article for more information and findings.

“Patients might be shocked to learn that women in the United States still die in childbirth. Fortunately, this is a rare event. An important aspect was the potential contribution of cesarean delivery to the maternal mortality rate, especially when we consider the trend toward elective cesarean delivery. Clark et al tapped a large database from the Hospital Corporation of America to examine maternal deaths that occurred among close to 1.5 million deliveries. Their findings sparked a lively conversation.”

“When we counsel patients about cesarean delivery, we should always describe risks and benefits. Risks typically should include surgical complications such as bleeding, infection, and damage to internal structures. It has been my experience that the catch phrase “increased risk of death” is included uniformly, but I personally find it somewhat difficult to pin down this risk in exact terms and numbers. It can also be somewhat difficult to describe to patients exactly why they might be at risk for dying. For that reason, the new study by Clark et al was a very interesting read.”

“The authors’ observed maternal mortality rate was 6.3/100,000 over a 6-year time period, which is approximately 50% lower than the Centers for Disease Control and Prevention’s reported national rate of 13/100,000 for 2006. Their lower rates may have reflected the disproportionate number of private hospitals that were included in the study sample. Cesarean delivery rates in the study were comparable with national rates, nearing 31%.”

“An important fact is that the maternal mortality rate in this country is actually climbing, which is a more recent trend. Somewhat surprisingly, this study found a mortality rate that was roughly 50% of the reported national rate.”

In this UK study, they found:

“The case fatality rate for all caesarean sections is six times that for vaginal delivery, and even for elective caesarean section the rate is almost three times as great. These differences are highly significant. In the absence of other evidence (eg, from randomised controlled trials of different modes of delivery), it is not appropriate to be dogmatic about best practice, but any decision to undertake major surgery with an associated mortality should be taken very seriously by all concerned.”

tattoo in pregnancy

Concluding thoughts…

The numbers you get completely depends on which studies, abstracts and information you are looking at.

From what I found on AJOG, the mortality rates for women does increase in cesarean sections (which more women are asking for as a choice, not for medical reasons), but not as much as the original article claimed. It was however, an 1100% difference from vaginal birth vs. cesarean according to the study I did find.

In the UK Study, maternal death rates were 3 times greater with planned, elective cesareans than vaginal births.

Also, maternal deaths in birth is rare, but rising and at 6.3 per 100,000 (CDC says 13 per 100.000).

Main risks for cesarean section include surgical complications such as bleeding, infection, and damage to internal structures.

I’ve been trying to find a way to say that the increased risk is in fact not too much higher, but it is. In comparing VBAC’s (uterine rupture rates, not death), it is .07 for all women vs. apx .5% for VBACs which is a 614.3% increase chance of rupture (again, not death). Where it is an 1000% increase risk of death for cesarean vs. vaginal birth.

In the UK they found the case fatality rate for all caesarean sections is six times that for vaginal delivery, and even for elective caesarean section the rate is almost three times as great. These differences are highly significant. In the absence of other evidence (eg, from randomised controlled trials of different modes of delivery), it is not appropriate to be dogmatic about best practice, but any decision to undertake major surgery with an associated mortality should be taken very seriously by all concerned.

In the end, we are dealing with small numbers of .07, 0.2, 0.5 and 2.0 percents. That means 98-99+% of the time, birth happens without complications!!! Do your research, birth how you feel is best for you and find a competent and supportive midwife or OB to reduce risks either way.

* Percent increases found using this tool.

**More info here and here.

Home Birth is NOT 3 Times More Dangerous Than Hospital Birth

Home Birth is NOT 3 Times More Dangerous Than Hospital Birth

I have recently read people saying “Home birth is 3 times more dangerous than hospital birth” and “You will only birth at home if you do not care if your baby lives or dies”. Wow. If home birth is that much more dangerous than birthing in the hospital, that needs to be taken seriously!

If it were true. It’s not.

birth without fear

Mama Birth recently wrote this blog post on her blog highlighting the findings from a home birth study. One thing I love about Mama Birth, is whens she shares her opinion she states just that…it’s her opinion. When she shares information, she always backs it up. If she is wrong, while not easy, she will correct herself.

After writing this article where studies found home birth as safe as hospital births an unlicensed medical doctor came on to dispute what she shared. This unlicensed doctor claimed that home birth is in fact three times more dangerous and your baby will die in home birth. She linked to her own OPINION about the article and never once backed up anything.

Mama Birth researched the topic more extensively (as she thought maybe she was wrong and wanted to correct her blog post if she was) and all she found was more research to back up home birth being as safe as hospital birth. Upon further debate, she realized what this unlicensed doctor is doing.

I quote from Mama Birth:

“The 3X more dangerous statistic is not from a study. She (the unlicensed doctor) used the Johnson and Davis home birth study (which found home birth safe), then added BACK IN all the home birth babies that had died (one was known still BEFORE labor, others had congenital abnormalities that would have resulted in death no matter where they were born). She added those BACK IN and then got the 3X more dangerous number.

Sounds fair- she said it was because the hospital had to include numbers like that- EXCEPT THEY DIDN’T. The hospital numbers REMOVED high risk situations like that too.”

See, anyone can take a study or statistics and twist them to make them work for their benefit. Including an unlicensed doctor.

Breech Birth Statistics

Breech Birth Statistics

This article by Richard Fischer, M.D. gives eye opening and reliable information about breech births.

Vaginal Breech Birth

Types of Breeches

  • Frank breech (50-70%) – Hips flexed, knees extended (pike position)
  • Complete breech (5-10%) – Hips flexed, knees flexed (cannonball position)
  • Footling or incomplete (10-30%) – One or both hips extended, foot presenting

Percent of Breech Babies

Breech presentation is defined as a fetus in a longitudinal lie with the buttocks or feet closest to the cervix. This occurs in 3-4% of all deliveries. The percentage of breech deliveries decreases with advancing gestational age from 22% of births prior to 28 weeks’ gestation to 7% of births at 32 weeks’ gestation to 1-3% of births at term.[1]

96-97% of babies will turn head down prior to their birth (97-99% if born at term).

Predisposing factors for breech presentation include prematurity, uterine malformations or fibroids, polyhydramnios, placenta previa, fetal abnormalities (eg, CNS malformations, neck masses, aneuploidy), and multiple gestations. Fetal abnormalities are observed in 17% of preterm breech deliveries and in 9% of term breech deliveries.

Of the 1-3% of term breech babies, there is a 9% chance of fetal abnormalities being present. It is higher in preterm breech deliveries.

Perinatal mortality is increased 2- to 4-fold with breech presentation, regardless of the mode of delivery. Deaths are most often associated with malformations, prematurity, and intrauterine fetal demise.

The perinatal mortality rate does increase with breech presentation, but that is REGARDLESS OF THE TYPE OF BIRTH! The increased death rate is due to malformations already present, prematurity and intrauterine fetal demise!

Thoughts

Wait. Be patient and keep an eye on baby. Most breech babies will turn head down. Also, prematurity increases risk of death. Wait for that baby to fully develop so s(he) is ready to be earthside (don’t induce or have an early cesarean if there is no medical indication to do so). Most issues with breech births are because of other factors and not because of where baby is born.

Uterine Rupture: A Look At 20 Peer-Reviewed Publications

Uterine Rupture: A Look At 20 Peer-Reviewed Publications

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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