By Bethy Young
After women receive their Special Scar, the first thing they are usually told is they will never be allowed to labor again. Often, this warning is expanded to other recommendations including delivering any future babies weeks before term by repeat c-section or even a verbal warning against having future children at all. When pushing for answers, it all comes to one thing: the risk of the dreaded rupture. But what is a rupture and why do we fear it?
Unfortunately, the word “rupture” is over-utilized by the medical community. Sometimes, a medical professional will label a small one-layer separation or a uterine window as a rupture. The truth is that these are not true ruptures. Uterine windows, also known as dehiscence, asymptomatic separations, or incomplete ruptures, are actually when tissue in the uterus stretches so thin during pregnancy that you get a “window”, gap or thin patch. Uterine windows often go unnoticed until a later cesarean or even after delivering with a successful VBAC since the only time windows are found is during a cesarean! Stretching of the uterus is normal and it is unknown how often these windows actually happen during vaginal births.
So then, what is the true definition of a rupture? A complete uterine rupture is a tear through all three layers of the uterine wall. They most commonly occur along the scar line of a previous cesarean mom, but can occur anywhere on the uterus (Gerard G. Nahum, MD). They can also occur in women who have never had a cesarean. The most common causes other than previous c-sections or other uterine surgeries are weak uterine muscles after several pregnancies, maternal age and overuse of Pitocin as well as other induction methods (The Lin Study). It often becomes frustrating and confusing when a woman seeks information and learns that there is no common terminology used throughout the medical community. The terminology that one OB uses will often be totally different then the next and often depends on the university they attended or where they did their residency.
No matter the real meaning of a rupture, most Special Scar moms seeking VBAC have been told they have to have a repeat c-section due to the risk of the dreaded rupture. Women are often quoted obscenely high percentages with refusal to give out proper research to back up the claims when it comes to a VBAC on a Special Scar. The truth is that the risk of rupture for women with Special Scars is only 1.9%. To put that in perspective, there is less than a 2% chance that your VBAssC will end in a rupture (Landon, 2004).
It is important to know that not all ruptures are catastrophic in nature. In fact, most studies agree that only 6% of ruptures are catastrophic, meaning mom or baby dies (2010 NIH VBAC Conference). Some studies even go as low as saying only 0.03% of all ruptures are catastrophic (Optimal Care in Childbirth by Henci Goer and Amy Romano). That extends to include all ruptures: Special Scars, low transverse, and non-sectioned uteri alike. Most catastrophic ruptures are symptomatic ruptures. During a symptomatic rupture, all three layers of your uterus separate completely and the baby will be pushed into the abdominal cavity. If the amniotic sac ruptures, the baby is put into immediate danger. On the other hand, the most common type of rupture is an asymptomatic rupture. During an asymptomatic rupture, the tissue separates partway along its length and the amniotic sac stays intact with baby still in the uterus. Bleeding and shock is minimal for the mother and the baby usually survives (Midwifery: Preparation for Practice).
Regardless of the surprisingly low risk of having a true rupture, almost all of us worry about the risks and how it could affect our babies. As mothers who have undergone often traumatic first time birth experiences, we tend to see the big picture, we want the best for our babies, we want what is best for us and we want a good overall experience and outcome. We often hear of Special Scar women talking about the hours and hours worth of research and soul searching that has gone into our decisions to have a VBAC. It is not a decision we rush or take lightly.
If you are worried about rupture, you can decrease your chances by avoiding any labor augmentation including Pitocin or other induction methods when possible (The Lin Study). Rupturing does not automatically mean you lose your uterus or your chance of having more babies. Many women who have ruptured have gone to have more children after letting their rupture heal.
The choice to have a VBAC after a Special Scar is a very important decision that only you can make! To read more about the studies cited and other studies related to ruptures and special scars please visit the Special Scar Study Page. I urge you to use the studies to make the best decision for you. Also feel free to share this post with your loved ones, care providers, and anyone else who may have questions about ruptures.
Please feel free to look over our reference list for your own research needs!
Special Scar Study’s Page
Uterine Rupture in Pregnancy, Gerard G Nahum, MD
The Lin Study, Carol Lin, MD, B. Denise Raynor, MD
The Landon Study published in The New England Journal of Medicine
2010 NIH VBAC Conference
Midwifery: Preparation for Practice
Optimal Care in Childbirth by Henci Goer and Amy Romano
specialscars.org 