planning to have a vbac but worried about scare rupturing

[louise012]

im 36wks and planning to have vbac but now worrying about my scare ruptuing has this ever happend to anyone?

Hi

I had thinning of my lower segment last time, however I had other major complications owing to this so know these were the reasons.

If your pregnancy has been uncomplicated and the c section previously was a straightforward one (as in you didn't have thinning of scar before) then its a really really low risk. I think something like 0.5%.

You'll be monitored throughout labour and there's usually a lower threshold for going to theatre when you've had a prev cs.

It is a very unlikely occurrence, there are some things that make it more likely (like induction) which you can avoid. You might find vbacfacts.com useful, or it might scare you, it has lots of straightforward, evidence based information to help with informed decisions.

The risk of there being problems with your scar is pretty small. The risk of the problem being catastrophic is even smaller. Other things affect the risk too, what type of incision you had, how old it is, whether you have had any complications with the scar since, whether you are induced and if your labour is sped up with drugs. If everything has been straightforward and you avoid induction, the risk is low. If you are worried, maybe talk about it more with your doctor or midwife, maybe that will reassure you?

much much safer for mum and baby to have normal birth unless there are other factors. The risk of scar dehesion is tiny and actual rupture even smaller.

Trying to stay active even if you opt for continuous monitoring (it is a choice) by being upright and mobile as possible will help. Many vbacs are compromised due to the lying on the bed leading to epidural leading to further intervention leading to repeat section.

Try to read up, be positive that with a straightforward pregnancy a vbac is s better option for you both and get good support for your labour

Yes, not to me but my friend lost her 2nd child last year in exactly this way at 36 weeks. She'd had a section due to her first child being breech and was attempting vbac for number 2. She had no idea that scar rupture was a risk despite there being only being 15 months between her 2 babies. The risk is very tiny and being aware of it makes it less of a risk. She has since gone on to have a 3rd child but delivered early (32 weeks) via emcs after lots of monitoring and a 6 week stay in hospital. Despite all the extra monitoring and scans the obstetrician only realised that the only thing stopping her scar rupturing a 2nd time was the fact that she her bladder had adhered to it in her previous surgery. She was unusual in that she had 3 pregnancies in 3 years and had not waited the year recommended post cs before getting pregnant again.

louise012, here is a link to a recent thread about the risks of VBAC you might find useful - it contains a lot of links to info within it, IYSWIM -

www.mumsnet.com/Talk/childbirth/a1428925-Risks-of-VBAC

It is not true that a VBAC is 'much much safer for mum and baby'. That's just generalising misinformation I am afraid. For example, there is a greater risk of infant mortality with VBAC than planned caesarian - BUT it is important to point out that the absolute risk for both VBAC and repeat C section is very low.

This article from the BBC is a good summary - www.bbc.co.uk/news/health-17353803

It says: - "The risk of the baby dying was 1 in 6,000 in women trying for a natural labour after a previous section, compared with 1 in 18,000 for women having a planned C-section after a previous section."

There are various factors to take into account (like how recently the previous C section was performed) that will vary from woman to woman, and of course, risk is a VERY personal issue. We attach different values to the same set of risks, and therefore make different decisions based on what is important to us. Good luck.

Salvadory that is so awful Did your friend ever get referred to a consultant or was this the midwife making the decision?

I can't imagine any normal obstetrician not making the risk very clear to someone who had such a short gap between pregnancies - it is a known risk factor and failure to give this advice would be cited in litigation.

Fruitybread thanks for the link - very interesting.

The BBC article quoted above is quite misleading

see here for a breakdown http:www.scienceandsensibility.org/?p=4257#comments of the figures.

I just had an attempted VBAC, pushed but DD got stuck, no rupture all fine.

There are ladies on the yahoo vbac group that have had VBAC after 5 cs.

Salvadory that is tragic about your friend, though I am that no health care professional made the risk clear to her. I've just had a vbac and the risk was spelled out to me by every doctor and midwife I saw.

OP I just had a successful vbac and it was amazing. Much better recovery than my section (which was an EMCS), which was my main motivation as I have a toddler as well. The risk is small, but it's definitely something to consider. I personally decided to refuse induction and any augmentation (syntocin) as they increased the risk of rupture more than I was comfortable with. Good luck whatever you decide

Zhen Sciemce and Sensibility is a Lamaze site - I looked at the BBC report of the research and the actual research and it seemed a pretty good summary.

I could only use this link www.scienceandsensibility.org/?s=vbac

Why do you think the Lamaze site has got right?

It doesn't put the risks in perspective like the article you link to does, therefore making ELCS seem safer than it is when it is in fact major abdominal surgery. NICE recommend trial of labour (and hopefully VBAC) over repeat CS in most cases.

It doesn't talk much about what else happens with CS compared to VB i.e.

Increased with CS:

Abdominal pain
Bladder injury
Ureteric injury
Need for further surgery
Hysterectomy
ITU/ HDU admission
Thromboembolic disease
Length of hospital stay
Readmission to hospital
Placenta praevia
Uterine rupture
Maternal death
Antepartum stillbirth in future pregnancies
Not having more children
Neonatal respiratory morbidity
Transient Tachypnoea and Respiratory Distress Syndrome of newborn (1.5% at >39/40)

This site has some good facts that clearly breaks down the risk of uterine rupture based on research.

Having just had second EMCS and now with a toddler and a newborn to look after I would definitely recommend VBAC even though I didn't end up with a vaginal birth. If I have another I will be going for VBAC2C.

Zhen NICE recommend trial of labour (and hopefully VBAC) over repeat CS in most cases.*

I am not sure it does say that - it says women should be told the risks and benefits and have a choice - see extact below.

Some of the risks you have listed above are increased for VBAC not increased for CS: Uterine rupture and transfusion. There is no difference in hysterectomy. Neonatal death is also lower for repeat c/s.

Lamaze has an agenda - it is not like NICE which looks at the evidence. That said, I think VBAC is a perfectly good choice if that's what you choose but I don't think people should be bounced into it on the basis of slanted evidence.

From NICE:
When advising about the mode of birth after a previous CS consider: maternal preferences and priorities ,the risks and benefits of repeat CS, the risks and benefits of planned vaginal birth after CS, including the risk of unplanned CS.

Hi, I'm at 30 weeks and thought VBAC was what I wanted for most of pregnancy but just started to read some rupture birth stories and decided probably c section now for me! I know reading the stories was probably a ridiculous thing to do, but they are pretty scary!! Most of the c section stories don't seem to end in such trauma. I wish i hadn't had to have a c section first time round, but I did, and to be honest we all got on with it ok. No problems bonding, or anything like that. After reading lots of VBAC sites I've started to feel unusual in feeling safer with a c section as so many women seem so anti them second time round, but I'm terrified baby will harmed and I will have to have major surgery which puts me out of action much longer than a planned c section

But Rachel lets not forget its 0.5% or less for rupture. We have tools to guide us when someone is having a vbac with regards to rupture and if there's any doubt we act upon them.

I think it's really easy to think a elcs is a safer option, but I have seen lots of emcs, elcs and vbac and believe me not all elcs are without problems. In fact i think seeing these things is having a major impact upon my decision making this time, even after 2 previous cs and thinning of my lower segment last time. I will do a lot of research, discussion and thinking before coming to a decision about which way this time. I'd much rather a vbac over surgery any day is my gut feeling at present.

As others have said do lots of reading (reputable evidence too) and ask if your unit has a vbac specialist midwife and obstetrician who will go through your notes as to why you had a cs last time, and then you can make an informed choice. It's a tough cookie though, I agree.

Mine nearly did causing the potential loss to dh of his wife and new baby. You need to have the monitor on as soon as you start pushing if not before. I am not having any more babies now as the risk is too great.

Had a very successful vbac 16 months after having an emcs for failure to progress.
Had a doula for my vbac and she helped greatly! I clearly recommend having one if u consider a vbac.

Good luck!