QuestionHello, I have a question about uterine rupture. I just found out that i am pregnant with child #4. I am currently 8 weeks. I have had three previous c sections. First because the baby was breech and the 2 following were repeats. When i had my last c section one year ago, my doctor told me that my uterus was very thin and he said I really shouldn't have and more babies because of a higher risk of uterine rupture. He wanted to do a tubal but I refused. Later I decided that I should probably listen to him and decided not to have any more. Well after one time of unprotected sex I am pregnant. I am very concerned about what he said to me, and i am now concerned for my life and the life of the baby i am carrying. I have done as much research on this as i can but come up with very little. But it seems to me like this is now the "thing" that doctors are telling women after 2 or 3 c sections. I can find where lots of women are told this same thing, it seems like they are all wondering the same thing as me. How risky is it really? Doesn't the uterus naturally thin in the end of pregnancy anyway? If I never go into labor what is the problem? Can a kick from baby rupture my uterus? I am so worried I haven't slept for weeks. I go to the doc tomorrow, but I just want more opinions. Thank you , Jeni
AnswerFirst, please understand that every cesarean section multiplies the chance for maternal death. I don't want this to scare you at all but I do want you to be aware of this. Every c-section is major abdominal surgery. Your doctor's concerns are very valid and very serious. This is not something that doctors are just telling people without cause. In addition to it seriously increasing the chance of death, it also increases the chances of a forced hysterectomy. I am surprised that before your second and third c-sections, your doctors at the time didn't inform you of this.
The uterus does naturally thin at the end of pregnancy but if it is already thin at the beginning of it, there is a higher chance for uterine rupture. While a kick from the baby is unlikely to cause it to rupture, growth of the baby itself may. In addition, the uterus has scar tissue from previous cesareans which may also be problematic. However, this is an issue that has become a forefront problem for doctors as the cesarean rate has risen in this country. With careful monitoring, it is possible to carry the baby to term. However, your doctor may recommend bedrest towards the end of the pregnancy as well as other precautions to help avoid a rupture.
Please take your doctor's concerns seriously. Don't let it terrify you or make you anxious but please don't pass it off as something they're "just telling" you. Keep a good conversation going with your doctor and heed his/her advice and recommendations. In addition, you may be referred to a specialist that deals with high-risk pregnancies such as yours regularly and can help your specific needs. Remember that every woman is different and only your care providers (and you) know the condition of your uterus. =) Thankfully, you're giving birth at a very good time where lots of strides have been made in obstetrics. Your caregivers want you and your baby to be healthy just as much as you do. =) So please try to take comfort in knowing that you have a whole medical team available which will do everything in their power to keep you and your baby safe.
Please try to relax and get some sleep. =) Being anxious and putting your body under more stress won't help. You may want to mention your insomnia to your doctor as well and see if he/she can give you something to help with it. I also recommend considering having a tubal ligation after this pregnancy if your doctors determine your uterus is still thin.
Please let me know if I can help you further or with anything else.
Best wishes,
Helen =)
