About Uterine Ruptures, and the Remarkable Human
Uterus
-by Kathy
A.L.
Question:
"Can I have a VBAC after vertical c-section?"
Response by Kathy, mother of 12 (1 hospital
vaginal birth, 3 c-sections, then 8 home VBACs!):
"I want to give you as thorough a reply
as I am capable of.
First, I have some questions for you. Do you
know if you have a lower vertical incision or
a classical incision? Do you know how far up towards
the fundus (top) of your uterus your scar reaches?
Also, are you sure that the scar on your uterus
is vertical? Sometimes they will do a vertical
incision on the abdomen and a transverse incision
on the uterus.
I think if you have that information, it may
help you in your decision making process as you
gather information regarding risks of VBAC as
opposed to risks of elective repeat cesarean section
(ERCS).
Due to the fact that the surgery was done prior
to the term of the pregnancy, it is a good possibility
that the uterine scar is vertical. The reason
for this is that before term, the lower segment
of the uterus has not formed yet. That is why
a vertical incision must be made. When a vertical
incision is made, they must cut through uterine
muscle. The further up towards the fundus the
incision is made, the more risk the scar carries.
When a lower transverse incision is done, they
are cutting through thinner connective tissue.
During labor, there is more stress on the muscle
than on the connective tissue. This is why there
is a slightly higher risk of rupture with a vertical
incision as opposed to a transverse one.
When a rupture occurs with a transverse incision,
it is most likely to be benign (as long as oxytocins,
prostaglandins, or misoprostol are not used.)
With a vertical incision, the disruption can be
more serious resulting in severe complications.
Most often, if the scar is going to open up, it
is said that it happens during pregnancy. However,
there have been cases where it has happened during
labor. (I would highly advise you to not allow
any induction or augmentation, rupturing of membranes,
forcep or vacuum extraction to be used.)
Risks with various incisions:
Low vertical: 1.3% Classical: 2.2% to 4% (Statistics
from Holistic Midwifery, by Anne Frye.)
Now, having given you these statistics, I will
present it this way:
Chances of not rupturing:
Low transverse: 99.5% to 98% (depending on the
study)
Low vertical: 98.7%
Classical: 97.8% to 96% (depending on the study)
If we were to read birth stories from these 100
women who had classical incisions, 96% would have
had a VBAC. 4% would have had a problem with their
scar. I am not sure what percentage would have
had a perinatal death. (You may find that info
in Henci's book.)
There has never been a maternal death as a result
of a VBAC. There has been infant mortality. (96%
of the deaths have been a result of Classical
incisions.) I have gotten these figures from Mrs.
Goer's book. I have read anecdotal stories where
women have lost their uteri and their babies.
There have been maternal deaths with Cesarean
section. There has been infant mortality. There
is also more maternal/perinatal morbidity with
Cesarean section than there is with vaginal birth.
Again, I have read anecdotal stories where women
have lost their uteri as well as their babies.
I am giving you this information just as I would
present it to my own daughter. Clearly, with a
classical incision, your future childbearing has
been made more complicated, as it has even for
those of us with any other type of uterine scar.
We must all study the risks, and choose for ourselves
what we think is best. I have done that in my
own life, and considered what the worst case scenario
would be, and have thought about what I would
do in that situation.
I am sure you would like to see statistics. It
would take me a long time to get into that, so
my suggestion is that you purchase a copy of Obstetric
Myths Versus Research Realities by Henci Goer
so that you can make an informed decision. Using
this book, you will be able to see the results
of studies that have been done. Mrs. Goer translates
a lot of the medical literature into language
we can all understand. I highly suggest that you
buy that book.
If you decide that a vaginal birth is the way
you would like to have your baby, I would highly
suggest that you from this day forward maintain
an excellent diet so that your risk is reduced
even further than the average woman's. I will
include some information explaining the growth
of the uterus during pregnancy so that you can
see how important nutrition would be for building
a healthy, strong uterus. Become a student of
what really is good nutrition. Hint: Fresh fruits,
fresh vegetables, whole grains, high quality protein,
and adequate fluid intake. Also, I would suggest
a wonderful product on the market called Barleygreen
to be taken everyday. I truly believe that if
women follow this measure, their risk would be
decreased.
I have some food for thought for anyone who feels
anxious about their uterine scar. The non- pregnant
uterus weighs about 60 g., or just slightly over
2 oz. It's size is 7.5 x 5 x 2.5 cm. In English
measurement, that's almost 3" x 2" x
1". At the end of pregnancy, it weighs 900
g., or almost 2 lbs. It's size is 30 x 23 x 20
cm. That's almost 12" x 9" x 8".
The uterus enlarges so that it can give nourishment
and protection to the baby. Each muscle fibre
increases 10 times in length and 5 times in thickness,
and new fibres are produced. These fibres are
preparing for the remarkable feat of labor.
When a mother has good nutrition, she can be
sure that her uterus is a good, strong muscle,
capable of doing it's job. I have read that sometimes
in a repeat c-section, the surgeon cannot even
tell where the previous scar was. This development
of new uterine fibres explains the reason why
a uterus with an incision has good integrity.
Poor nutrition can cause a weaker muscle. It
is so important to eat a very good diet, and even
to take organic supplements. (These are much more
absorbable than synthetic supplements.)
Also, if you decide to have a vaginal birth,
I would highly suggest that you read Silent Knife
by Nancy Wainer Cohen. It will certainly empower
and strengthen you, as well as educate you further.
You may find it difficult to find a care provider
who will help you to try to have a VBAC. Even
with the low transverse incision which carries
a lower and more benign risk, women are having
a very difficult time finding someone to help
them VBAC without a lot of grief. You would do
well to really educate yourself. Read, read, and
do more reading.
If you decide that you would opt for an elective
repeat cesarean, I would suggest that you request
the incision be a lower transverse uterine incision.
I would also still suggest that you follow an
excellent diet.
I hope that answers a few questions for you.
But I really think that you should get Mrs. Goer's
book so you can make an informed decision."
To read about the book "Obstetric Myth
Versus Research Reality", and to order it
online, go
here.
Note from LLM, site editor: two
other ways to strengthen the uterus are: 1) lots
of orgasms, and 2) drinking red raspberry leaf
tea tones the uterus as well. Buy it at health
food stores.
Here is what a mother with three previous cesareans
who went on to have a VBAC did to increase the
strength of her uterus:
"To help prepare my uterus, I've been
drinking Red Raspberry Leaf tea for several
months. I am just starting to take PN6, a combination
herbal product that is supposed to help strengthen
and prepare all my pelvic organs.. " Read
her story here.
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