Monday, November 19, 2012
Fear of Rupture
I received a Facebook message from someone wanting to have a VBA2C, but dealing with a lot of fear. I sent the message on to Abbey Robinson. I asked if I could post it here. I hope you will find it helpful if you too are wanting a VBAC but dealing with the fear that is spoon-fed to our VBAC mamas.
First of all, congratulations on your pregnancy. I, personally, had a VBA3C so I can definitely understand where you are coming from. VBAC is a huge commitment and learning everything you can about the process is crucial to success.
I think that it’s normal to be fearful when you hear so many scary stories on the internet and through friends, family, and acquaintances. From what I am hearing, your major concern is that you may not know/feel when/if you have a uterine rupture. I will try to address this for you.
I never speak in absolutes regarding anything, so I’m not one of those people who will reassure you that there is no risk and everything will be fine. Simply being pregnant and carrying a baby has risk. Having a 3rd c/section places you at risk for many complications, much more than your 1st c/section would have been likely to cause. Your risk of
• major complications is a whopping 7.5% (including but not limited to are listed as uterine rupture, hysterectomy, additional surgery due to hemorrhage, injury to the bladder or bowel, thromboembolism, and/or excessive blood loss.)
• Placenta accreteta: 0.57%
• Risk of hysterectomy: 0.9%
• Risk of blood transfusion: 2.26%
• Risk of dense adhesions: 32.2% (can cause life long pain/bladder and bowel problems/back pain (from everything sticking together) and will heavily complicate any future c/sections) If you want statistics on a 4th c/section (if you plan to have more children, let me know. The risk goes up many more times for each complication)
That leaves you with VBA2C and the risk of “uterine rupture”.
There was an Australian study of over 29,000 women who spontaneously went into labor where the risk of UR without augmentation (pitocin, prostaglandins, cytotec, etc.) with one prior incision was found to be a very low 0.15% Once you introduce labor augmenting and induction drugs, the risk of uterine rupture increases to 1.91%. HUGE difference. From the studies that have been done on VBA2C or more, there isn’t much difference in the UR rates. Cochrane reviews have identified true UR rates to be around 0.4% when no augmenting drugs were used. Most of those cases were uneventful and mother and baby were healthy and fine.
SOOOOO, now that we’ve established that statistically, you have much better odds of having a VBAC with no uterine rupture than the risks of having a 3rd c/section, let’s talk about what you might feel and how to identify a UR.
Much of what we refer to as ‘uterine rupture’ is what is medically known as ‘dehiscence’ or a ‘uterine window’. This is where the scar tissue begins to separate but a thin piece of tissue is left so the muscle doesn’t completely rupture but it’s so thin you might even be able to see through it. Even though this ‘window’ is included in the statistics for ‘rupture’ when it is identified (usually when a mother is having a RCS either scheduled or after a trial of labor) It has mostly been found as harmless…usually no repair or special care is needed and it heals on it’s own. There’s not enough information to know if it increases your risk of rupture for the next pregnancy or not. But if you didn’t have it last time, there is no reason to believe you will this time.
Sometimes a rupture is painful. Sometimes there is absolutely no doubt that you are having one, but as you have found out, it’s not always that way.
What WILL happen is your body will act differently. If your uterus has a tear, it will not function like it did before. It may become boggy and limp. It may suddenly change shape. You will probably have actual bleeding (bright red blood rather than normal bloody show). As long as you are not medicated (don’t have an epidural or narcotics) you will feel that something is different.
Much of the time, when a mother goes back for a section and there is a dehiscence, the OB will make a point to tell the mother that her uterus was rupturing, she is then terrified into scheduling a RCS for any future births. The OB only knows what he has seen and the mother only knows what she is told and even though there was no negative outcome, both are scared of VBAC from then on.
As long as no harm was done, there is no reason to assume that it’s a dangerous situation. The pregnant body is AMAZING, and if there is a problem with your uterus, most of the time it will send that signal to your body and labor may slow or even stop to protect itself. Contractions may space out and be gentler on you than if you didn’t have a scar. Embrace it and enjoy your labor. Even when babies are stressed out, the body will get the message and contractions will not intensify, changing positions will get things going again, because baby is getting more oxygen and sending the signal to get going again.
NOW, catastrophic uterine rupture is what we are really afraid of. It’s what we always *think when we hear the term “uterine rupture”. This is when the baby literally breaks the uterus and is born into the abdominal wall. You better believe that this will be painful and you will bleed and this is very scary and dangerous. It accounts for a VERY VERY tiny percentage of the statistics. It has most often been reported with labor induction and augmentation. We hear a lot about this kind of rupture when we think of induction on a VBAC with cytotec.
Find out if you have an anterior placenta (the placenta is on the front of your belly, near the old c/section scar). An anterior placenta makes UR more dangerous and gives you only minutes to get to the operating room.
Do you have access to your OP reports from previous c/sections? Do you know how you were sewn up? Double sutures don’t matter quite as much as whether the OB took time and care sewing you up.
No one can promise you any specific outcome. You have to be willing to be accountable for the risk of either VBAC or RCS. No choice is 100% risk free…but statistically you are MUCH safer having a VBAC than you are having a 3rd c/section.
I will promise you that if you are not able to let go of the fear and apprehension, you will sabotage your ability to labor and give birth. Please find a way to move past your fear. I highly recommend a great childbirth class, yoga classes, stellar diet (to build strong, healthy muscle tissue), seeing a Webster-certified chiropractor (to make sure that everything is lined up correctly and prevent obstructed labor and decrease the risk of rupture) Make sure your chiropractor can come and adjust you during labor to help things move along or keep them going. www.spinningbabies.com is the most amazing resource for getting and keeping baby in a good position so that you aren’t ‘stuck’ in labor.
Do everything within your power to have an uneventful labor and your risk of rupture goes down. Belly breathing was HUGE for me in labor and I believe it made the difference between success and failure for me.
Ultimately, you have to be willing to accept the risk of getting your baby out, one way or another. Build yourself up and be positive if you go through with labor. Read positive affirmations daily out loud.