It is important to understand your options for childbirth, specifically focusing on vaginal birth after cesarean (VBAC). While uterine rupture is often highlighted as the major risk, it's important that we break it down clearly so you can make the most informed decision about your childbirth plan. Remember, uterine rupture is an extremely serious but very rare event. Choosing to attempt a VBAC can be a safe and beneficial option for many women, so let’s delve into its aspects together.

First, what is uterine rupture? It occurs when there is a tear in the wall of the uterus, often at the site of a prior cesarean section incision. A complete rupture means the tear goes through all uterine layers, opening the uterus to the abdominal cavity. In such cases, an emergency cesarean section becomes necessary. In rare and severe instances, the baby might be pushed into the mother’s abdominal cavity. Women experiencing a complete uterine rupture may need a blood transfusion and, on occasion, a hysterectomy. However, let’s remember this is quite rare, with less than 1% of women with a prior low transverse incision experiencing it, and even less leading to fetal death.

As we consider your VBAC options, knowing whether you’re at increased risk for uterine rupture can guide our planning. Women who have had a classical or T-incision are at a greater risk since these incisions are located in the upper uterine segment, which might not handle labor contractions well. If you’ve experienced such scarring, your healthcare provider might recommend a scheduled c-section before labor begins. Additional risk factors include multiple prior cesareans and short intervals (less than 18 months) between pregnancies.

Understanding and preparing for rare risks such as uterine rupture is an integral part of decision-making. The National Institute of Health and the American College of Obstetricians and Gynecologists both emphasize that a “trial of labor is a reasonable option for many pregnant women.” However, this should take place in a facility equipped for emergency delivery so risk management is optimal. You and your baby’s wellbeing will guide us: you’ll have continuous monitoring, and it's crucial to notify healthcare providers of any severe abdominal pain that persists between contractions or any unexpected vaginal bleeding.

Partnering with a healthcare provider who supports informed and shared decision-making helps create a plan tailored just for you. Your health, your baby's safety, and your personal preferences matter greatly. If VBAC and a repeat cesarean delivery present equivalent medical outcomes for you, let’s lean into shared decision-making, acknowledging and respecting your preferences in conjunction with your care team's guidance.

Engage actively in dialogue about delivering vaginally after previous cesarean surgery and feel empowered in making a choice that resonates with your personal health circumstances and priorities. Equip yourself with knowledge, engage with your support team, and embrace this journey with confidence.

Sources:

1. Vaginal birth after previous cesarean delivery. Practice Bulletin No. 115. American College of Obstetricians and Gynecologists. Obstetrics & Gynecology. 2010; 116: 450–63.
2. Cunningham FG, Bangdiwala S, Brown SS, Dean TM, Frederiksen M, Rowland Hogue CJ, King T, Spencer Lukacz E, McCullough LB, Nicholson W, Petit N, Probstfield JL, Viguera AC, Wong CA, Zimmet SC. National Institutes of Health Consensus Development Conference Statement: Vaginal Birth After Cesarean: New Insights. March 8—10, 2010. Obstetrics & Gynecology. 2010; 115(6):1279–1295.