Comparison of Risks of
VBAC.
Foreword by Jackie Mawson.
When I posted the following article, on the Ozmidwifery
Chatlist, about the relative Risks of VBAC in relation to
accepted everyday risks (the article is in this magazine,
called 'Uterine Rupture Risk Comparisons') I had a response
from a few midwives that I would like to share with you
all…
*********
"If my understanding is correct, scar dehiscence
(breakdown) is not the same as uterine rupture and is rarely
fatal. It should not be equated with fatal incidents.
Kathleen Fahy"
===================
"Dear Jackie
I always find it interesting that most doctors would be
insulted and defensive if you were to suggest that probably
any other body part which they had operated on would
malfunction/ come apart on normal usage, or not ever be used
as designed following healthy healing?
Denise"
================
Many studies have shown that it is safer to birth your
baby vaginally, even after more than one c/section, than to
have an elective repeat c/section for no medical reason.
It's safer for your baby and for you. I can't think of one
study that has the opposite conclusions! The problem is that
most Ob's make the 'risk' that VBAC women take sound like a
life-threatening event (for baby at least) and therefore
most women don't have a full understanding of the risks,
pros or cons of VBAC birth vs repeat elective c/section.
I, as Convenor of Birthrites, endeavour to inform women
of the difference between rupture and dehiscence, and that
the most catastrophic uterine ruptures tend to occur on
'unscarred' uteruses, usually on women who are being
induced/augmented.
*Please note a study about uterine rupture rates, printed
in the BMJ 1996; 312: 1204 Ð 1205 (May 11), "In a study
of 32 cases (from 1 July 1993 to 30 June 1994) only 3 were
scarred uteri (from a previous c/section)."
When a rupture occurs on an unscarred uterus, usually due
to the mother being induced/augmented too strongly with
drugs, then the resulting rupture is catastrophic. Please
try to avoid induction/augmentation during any VBAC
attempts, as this will increase the risks of something like
this happening. The ruptures/dehiscence's occurring on women
with a scar are usually more like an unzipping of the scar
into a small window and are not usually serious - often they
aren't even repaired... I know of a woman who had a second
VBAC with an unrepaired uterine dehiscence!
Anyway, I will paste below a bit of information that was
sent to me last week; it may put the risk into perspective,
in regard to everyday risks that we consider acceptable.
There is a lot of fear surrounding our scars, far too much
focus on the dangers associated with the legitimate choice
of VBAC.
Please note that the risks listed below are fatal risks
where as the risks involved with uterine dehiscence (partial
separation of a uterine scar) often has no serious side
effects. Therefore the statistics quoted may actually be
higher than reality, or VBAC is even safer than the
comparisons made below… Know what I mean?
Birthing Beautifully,
Jackie Mawson
=======================
Reference - Website Address: http://www.gentlebirth.org/archives/vbacrisk.html
Relative Risks of Uterine
Rupture
After checking, it seems I was a bit off on the frequency
of deadly lightening strikes... you are more likely to
suffer a rupture than to be struck and killed by lightening,
by about thirty times. Then again, how many people do you
know who HAVE been struck and killed by lightening?
Ruptures are also more common than dying in a plane
crash. Henci Goer's review of the literature on VBACs found
46 ruptures in 15,154 labours. This equates to a 0.3%
rate... or 1 in 333, if you prefer. Your annual risk of
dying in a plane crash is 1 in 4000, according to one
source, and 1 in 700,000 according to another. I can't
explain the massive discrepancy between the two figures,
except to quote Mark Twain about "lies, damn lies, and
statistics."
Since you asked, here are some more probability
statistics for you:
- Your risk of dying in a car accident, over the course
of your lifetime, is between 1 in 42 and 1 in 75. This
is roughly 4 to 5 times greater than the risk of uterine
rupture.
- You're about twice as likely to have your car stolen
(that's an annual risk) than to experience a uterine
rupture.
- Your odds of being murdered are 1 in 140 over the
course of your lifetime. That's 2 times more likely than
the risk of rupture.
- The annual risk of having a heart attack is 1 in 160,
2 times more likely than rupture. Your risk of dying
from heart disease is roughly 1 in 6, or 55 times greater
than your risk of rupture.
- If you're a smoker, your risk of dying from lung
cancer is 1 and a half times more likely than a VBAC mom
rupturing during her labour.
- You're about 17 times more likely to contract a STD
this year than you are to have a uterine rupture; more
likely to contract gonorrhoea than to rupture, as well.
- You're 13 times more likely to get food poisoning
than to rupture.
- You're more likely to have twins than a uterine
rupture. Odds of twins: 1 in 90. That's about 3 1/2
times the likelihood of rupture.
- If you ride horseback, you're 3 times more likely to
die in a riding accident than you are to experience a
uterine rupture.
- If you ride a bike on the street, you are 4 times
more likely to die in an accident (annual risk) than you
are to suffer a rupture.
- Having a serious fire in your home during the next
year is twice as likely as experiencing a rupture.
- You're ten times as likely to win at roulette as you
are to have a uterine rupture.
- If you flip a coin, you'll be more likely to get
heads (or tails) 8 times in a row than to rupture.
- The risk of cord prolapse is 1 in 37 (2.7%), or
nearly ten times more likely than that of rupture.
And a final irony (heads up, those of you who want a doc
to give his/her opinion on your likelihood of rupture next
pregnancy!)...
- You're 6 times more likely to have a doctor who is an
impostor than you are to suffer a rupture. Two percent
of docs are phonies (1 in 50), according to several
sources I found.
So instead of worrying about rupture, why not take a few
minutes to check up on your doctor's credentials? It'd be a
more profitable use of your time, and a substantially more
likely cause for alarm.
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