VBAC in the US?

[DitaVonCheese]

My lovely cousin had her DS by EMCS (abrupted placenta) in the US at 30 wks gestation a couple of years ago. She is now pg with DC2 and still in the States (Manhattan if it makes a difference).

She is currently waiting to find out what shape incision was made in her uterus last time as this apparently affects the risk of rupture, ranging from 2-5%. From talking to her briefly, it sounds as though, if she's up the 5% end of things, she won't be allowed to attempt a VBAC. 5% to me sounds very low still (95% chance of not rupturing, presumably?) but then I'm not a consultant ob/gyn.

I know very little about the US system re this kind of thing but was wondering if there was anywhere I could point her towards for help/support/advice, or if there's anyone specific she could talk to if she doesn't get a VBAC. I know that she will do whatever she is told is best for her DC but she sounds genuinely regretful at not having a VB, hence me sticking my oar in

Please try not to be too critical of the US system unless you can back it up with stats, as it may be unhelpful

Thanks. Tbh my impression is that birth in the US is more medicalised than here in the UK but I'm not sure how fair that is and my cousin mentioned that she finds it irritating when people assume that they are automatically very pro-CS. Having said that, there was already talk before she had her DS of an ELCS because she is very petite and her DH is a giant so it was considered that her baby would be too big for her to deliver naturally

Is a 5% chance of rupture very high?

5% is 1 in 20.

That is pretty high, really. Not necessarily a reason to go for it as plan A, but to perhaps have a low threshold for converting to a C-section if any mishaps?

Just wondering where the 2-5% range for rupture came from ? I had EMCS last time and am hoping for VBAC this time round. Consultant has written "risk of scar dehiscence (separation) 1:125 (0.8%)" on my notes, which is backed up by a number of sources I have found on the internet. I haven't read anything which suggests a rupture rate of 5%, even for a vertical incision.

This is a useful article on scar rupture risk:

VBAC

From what I've read, I understand the VBAC rate in the US is much lower than over here due to guidelines which were issued a few years back which stated that VBACs should not be attempted unless there was a team available which was in a position to do an emergency c-section if required. Apparently not all birthing centres/hospitals have this, hence the move to refuse VBACs.