What is it that doctors usually say they are concerned about with VBACs? Uterine rupture. Let me tell you what I’ve learned about uterine rupture in all my research. If you are attempting a VBAC with a horizontal incision (vs vertical…and as far as I know, pretty much no one does vertical incisions anymore…and haven’t for some time…although there may be some docs totally out of it out there…) down low (the standard c-section these days is the “bikini cut” because these are the most safe, since that’s the strongest part of the uterus and heals best)…your chance of uterine rupture is about 1%…That’s less than 1 in 100. Maybe still a little scary, but lets put this in perspective…the risk of uterine rupture for a first time birth that is induced with pitocin is statistically HIGHER than 1%! (I haven’t been able to find a number for this anywhere, just references to it being higher.) So, its riskier to induce a first time mom, due to the risk of uterine rupture, but they do it all the time…and yet, its not an “acceptable risk” to allow a woman to have a VBAC???? Something that is statistically LESS risky???
Here’s something interesting about that 1% number…according to a local OB whom I trust, that 1% is also inaccurate. According to this doctor, it all depends on what they are classifying as a “rupture”…and they will often classify a “window” as a rupture…a window is a scar that has stretched so thin you can almost see through it (hence the term “window”), but has not broken. And many times these and minor tiny ruptures that never caused any complications are discovered when the mother has a c-section for a totally different reason and they just notice that its there when they open her up for this other reason…it never was a medical emergency itself. This doctor tells me he thinks the chance of a “catastrophic” uterine rupture, where the baby ends up outside the uterus, is more like 1 in a THOUSAND or even 1 in TWO THOUSAND. Its pretty rare. Most doctors have never seen one.
And another interesting thing to note…if you ask a doctor that has seen a catastrophic uterine rupture for more details of the emergency, you will find out some interesting things…every single one I’ve personally read about or heard about had pitocin and/or an epidural involved. Once you involve drugs in the equation, its no wonder that scary things happen! With pitocin you have unnaturally strong contractions forced on a cesarian scar, which is KNOWN in the medical community to GREATLY INCREASE your risk of rupture (yet they do it anyway, usually without telling the mom of the risks.) And with epidural, you can’t feel one of the telltale signs of rupture…sharp abdominal pain. So you don’t KNOW that something’s wrong, and neither do they. All this info just seems like such a “DUH!!!” to me…So if you go totally natural, with no interventions, your chance of a true emergency from uterine rupture is so very small…and in all I’ve read, the interventions that are standard procedure at hospitals these days are FAR RISKIER!!
Check out these articles for some very enlightening information:
VBAC Safety: A Closer Look at the 2002 JAMA Study
What Every Midwife Should Know About ACOG and VBAC: Critique of ACOG Practice
Vaginal Birth After Cesarean and Uterine Rupture Rates in California for 1995 (make sure to check out the stats at the bottom of this one)
VBAC and Uterine Rupture
It is also important to know that uterine rupture is not always fatal. They make it sound like your uterus explodes or something…but in actuality, from the midwives I’ve talked to locally who have decades of experience and knowledge, and all the info I’ve read…most uterine ruptures are NOT fatal, to mom or baby, if detected and acted upon appropriately. They can simply mean a tiny tear in the uterus and sometimes moms can still go on to deliver vaginally with this…although c-sections are most often done for ruptures…But moms and babies are not automatically going to die if you have a rupture! And being in the hospital does not guarantee that rupture will be noticed.
Fresno is so far behind the research when it comes to birth…many local midwives refer to Fresno as being in the “dark ages” regarding birth in general…VBAC particularly! You could go to Visalia or Selma and find a more enlightened medical community! Why is this? Why do we have to go to smaller, presumably less-advanced towns (big presumption there…just going on the thought that the bigger cities should have better resources overall…not so with Fresno), to find a more educated community in regards to birth? This is so utterly ridiculous it enrages me whenever I think about it! Birth is supposed to be a beautiful experience, not a fight!
So what can we, as Fresnans, do about all this? Demand better from our care providers. And in order to do this, you have to EDUCATE YOURSELF.