Uterine Rupture And Its Associated Risks

Some women opt for caesarean for their first as well as second delivery. A few women who would have planned a vaginal delivery might have to undergo a c-section due to unavoidable circumstances, for instance, baby in breech position. However, some of these women do look forward to a vaginal birth at the time of delivery of their next child. They may be trying to avoid the difficulties associated with c-section—which is basically recovering from a surgery as well as caring for the baby.

Normally, a woman can have a safe vaginal delivery after undergoing a c-section. Vaginal Birth After Cesarean (VBAC) is considered safe and doesn’t increase the risk of pregnancy complications.

Understanding Uterine Rupture

However, there is a very rare childbirth complication that can arise with VBAC. Uterine rupture is a life-threatening condition for the mother and the baby. It happens when the scar from the previous surgery ruptures along its length down to three layers of the uterus. The amniotic sac breaks and leading to the baby being pushed out into the abdominal cavity. As soon as the baby is

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being pushed out by the contracting muscles, the placenta gets detached from the uterine line, which completely stops the blood flow to the baby. Bleeding during the rupture can lead to hemorrhage in case of the mother, risking the life of both the mother and the baby. It requires a c-section to be performed immediately.

Cesarean Section Then And Now

Earlier, if a mother had once undergone a cesarean, she would have no option but to come under the knife the next time as well. This was to avoid the risk of uterine rupture.
During earlier c-section procedures, the incision was done from top to bottom on the women in lower abdomen region, which would take longer to heal. This was accompanied by the risk that if the mother didn’t go into labor during the second pregnancy, it would cause a rupture.

The methods of incision have changed with modern c-section, which is done horizontally and still lower in the abdomen region. This heals well, and reduces the risk of rupturing—this makes VBAC possible in a way. This must still be discussed with

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the obstetrician.

Obstetricians say that while considering for vaginal delivery after a c-section, the first step is to find out what led to the c-section the previous time. It could be due to mother’s health complications or pregnancy complications. In some cases of VBAC, if risks arise, the mother may need to go under c-section, for which your obstetrician will already be prepared.

Cases With Reduced Risks Of Uterine Rupture

The chance of uterine rupture is only 1% in case of VBAC and the risk of losing the baby in case of one is even lesser. The risks are greatly decreased if the delivery date is 18-months after the last c-section. You have lesser to worry about if you have had a previous successful VBAC or just one c-section. If the previous c-section was due to a less severe obstruction like breech position, which may not reoccur, VBAC shouldn’t arise any complications. The labor in case of VBAC is left to initiate on its own. A double layer suture during the previous delivery through c-section as compared to single layer one reduces the

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risks of rupture.

When To be Extra Cautious

The risk of rupture increases if the scar from the previous cesarean is a vertical incision or a T-shaped incision, made in the upper part of the uterus. If the mother previously had a uterine surgery, she needs to get the green signal from her doctor before proceeding for a VBAC. This also applies if a uterine rupture has occurred before—then, pregnancy itself can become a threat to the mother and baby.

VBAC can be a preferred choice for women whose earlier pregnancies didn’t go as planned. It gives the mother an option to deliver her baby in a calm and comfortable environment, where she can sit in a birth pool and freely enjoy the skin-to-skin bonding. It even allows her to recover soon and avoid all the medications and cautionary measures that a surgery demands, giving her the precious time to spend with her baby. However, the risk factors associated need to be considered because VBAC is another alternative and not the only choice.