QuestionHi there! I have a five month old, who was born via c-section because she was
frank breech, but I desperately wanted to have her naturally, no meds
nothing!ha! I even had them try turning her but nothing worked, so I was
forced to do a c-section and I accepted it cause it was the only way to safely
have my little sweetheart. And she wasn't very little after all, 8lbs 13 oz.
Anyway I talked to my OB about getting pregnant again soon but wanting to
have a VBAC and he said I was a prime candidate for it. But he also said there
is a 1% chance that I and the baby would die due to uterine rupture! YIKES! So
of course that scares me, but my question is...is it ok to get pregnant this
soon or is it safer to wait? My OB said it doesn't matter cause your scare heals
after 8 weeks. But he also told me to do some research too. Anyway if your
uterus ruptures is that it, will you die no matter what? Or can it rupture and
you and the baby still be saved? Sorry this is so long and detailed! I hope this
isn't a one question thing! ha! Cause I know I have well gone over! Thanks for
your time. Oh one more! ha! Is it really safer to have your baby via HBAC then
the hospital? Would you recommend that? Thanks again, Charity
AnswerThat statistic is incorrect. You have 0.5-1.0% chance of uterine rupture. However, that number includes benign dehiscences and windows, where the scar separates a little but there are no symptoms and no consequences; very few are catastrophic ruptures, where the baby is expelled into the abdominal cavity. For all uterine rupture occurrences, from benign to catastrophic, you have about a 0.5% chance of maternal or fetal death. That works out to an overall risk of 0.0025% of death in any given VBAC. You have a greater chance of being struck by lightning.
Even if you have a catastrophic rupture, chances are everything will still turn out okay. The only deaths I have heard of from rupture have occurred when an epidural has masked the symptoms, or when a mother has been ignored by hospital personnel until it was too late.
I personally recommend an out-of-hospital environment for VBACs. As long as your midwife has a good relationship with the hospital, she can be on the phone in the event of a transfer, having the doctors brought in and the OR prepped so that you can go straight to surgery when you arrive. Sometimes, the "call to cut" time can be faster in an out-of-hospital birth than in the hospital itself, because you have an attentive caregiver listening to you and monitoring you alone, not trying to watch machines on half a dozen different patients at once.
As for birth interval, some studies have shown an increase in ruptures for births that are less than 18-24 months apart. However, the increase was marginal and could have been related to other causes. Some doctors prefer the 18-24 month marker, while others, like your own, believe that the scar is fully healed in 2-3 months. Again, since the studies only showed a very small increase in risk with close births, it is not something that I personally would be concerned about.
