It is an obstetric emergency that those in the field are dreadfully prepared for but few experience. The data on uterine rupture is mixed, but most places you will find it hovers around 1% or less of all deliveries. Uterine rupture is a catastrophic tearing open of the uterus into the abdominal cavity. It can cause maternal or fetal death, the second of which is much more common. Being a survivor of a uterine rupture, I am not only asked a lot of questions but I also see a ton of misinformation out there about them. I’m here to provide some information, based on my anecdotal experience and what I have learned since that life-changing day.
1. I personally felt symptoms, but sometimes there are not any for the mother.
The only way I can describe the pain I felt is a contraction times 10 and the sensation that somebody was taking scissors to my abdomen and cutting it along my scar tissue. Graphic, I know, but I’m hoping if I’m descriptive enough it might convince a mom to advocate for herself in that situation. I should also note that I felt the pain in between contractions and through an Epidural. Sometimes though, moms don’t feel any symptoms and the rupture is discovered through fetal monitoring alone. Quick response to the onset of a rupture is incredibly important, so I’d encourage moms not to refuse this incredibly vital monitoring to protect themselves and the baby.
2. The guidelines that most OBGYN’s and hospitals follow exist for a reason.
Obstetric providers often do not allow VBAC attempts for women beyond 40 weeks gestation, who have had pregnancies too close together, and who have more than one transverse incision. They often will not induce or augment labor with drugs and will absolutely not allow VBACs in a hospital without a 24-hour team of providers and anesthesiologists to do an urgent surgery. These all exist for a reason! The risk of rupture increases quite a bit for each of those “rules” that are broken. Please know that doctors aren’t pro c-section or trying to crush your dreams or pushing their beliefs on you. They are trying to make sure you and your baby arrive safely. There will likely be no definitive answers on what caused my rupture, but my labor was augmented with Pitocin after twenty hours of labor, and I was almost 41 weeks. I would do anything to go back and change that if I had known this beforehand!
3. Response time is critical.
When my rupture was discovered, the code bell was pulled and all hands were on board within seconds. I was put under within minutes and my baby was delivered imminently. Still, my son was born without a pulse and without respiration, and needed resuscitation to survive. He suffered Hypoxic Ischemic Encephalopathy (HIE) and nearly died. In all, he spent 14 minutes without oxygen while he was floating in my abdomen without a lifeline. There is no time to do a homebirth transfer or to deliver in a hospital not equipped. I’d encourage you to find a provider that is affiliated with a hospital to meet your needs.
4. It can happen to anybody.
As illustrated with the precautions above, providers look at a variety of indicators on whether a woman will likely have a successful VBAC attempt. However, I was considered a prime candidate and still had a uterine rupture. I was 27, only gained 18 lbs, spaced my babies out three years, was in amazing health, had one previous transverse incision and the reason for my first c-section was not likely to repeat. I don’t say this to scare people away from attempting a VBAC if that’s what is considered safest upon discussion with their medical team. I bring it up because I did not have uterine rupture on my radar at all, and I had told myself it wouldn’t happen to me. I feel like had I understood the risks completely beforehand, and not gotten sucked into websites that weren’t credible, I maybe would have conveyed my symptoms sooner. There is also a small percentage of women who experience uterine rupture with no previous c-section or uterine scarring.
5. It’s incredibly traumatic for you and your medical team.
When a uterine rupture happens, it’s never not a big deal. There is no “tiny” uterine rupture or uncomplicated uterine rupture. There is no time to weigh your options. The only option is emergency cesarean section immediately. My medical notes describe the physicians opening my abdomen to see blood-stained amniotic fluid pouring out of me. It took a team of people to revive my son, stop my bleeding, save my uterus (which often doesn’t happen) and stabilize everyone. People trained in the obstetrics field see a lot and can obviously handle things professionally. That being said, those people are human beings and Uterine Rupture is one of the awful ones to see. In the time following my delivery, I’ve had a chance to talk to several of the people who were a part of it and each of them has said that evening has stuck with them and there are things they can’t unsee.
6. The experience can be very isolating.
Nobody around me experienced a Uterine Rupture, so I felt like there wasn’t really anybody I could talk to about my experience. People were nervous about what to say to me or around me, so people just avoided talking about what happened. I tried to find online support groups, but found many women in them were triggering to the PTSD I was suffering from, discussing wanting to try home VBACs or attempting another vaginal birth after a rupture. Finding the right counselor was key for me, and it took almost a full year of trial and error.
7. No positive outcome that could have come from having a successful VBAC was worth the risk of what I went through.
I have heard many people describe “healing births” or really positive VBAC experiences. I don’t want to take away the positivity of what that did for a woman. But because I experienced what I did, I know how awful it is and if I could go back and do anything, I would have opted for a repeat cesarean without a trial of labor. I often hear women say “I want to try for a VBAC because at least then I could tell myself I tried.” Much of this pressure is brought on by the mom shaming that happens in our society, the romanticism of vaginal births and the negativity surrounding C-sections. In fact, I wish there wasn’t so much focus on lowering the C-section rate because I believe this can lead providers to put off performing necessary C-sections when put in a position to make a judgement call. What I’m getting at is, there is no shame in not trying. Or to try if it’s what’s best for your situation. Just make sure what you decide is based on facts and conversations with your physician.
I am always happy to answer questions regarding Uterine Rupture and the impact it can have on the moms, babies, and partners who experience it. My hope is that despite its rare occurrence, more people share information and discuss it as a possibility in childbirth. The more patients and doctors informed on all aspects of Uterine Rupture, the better the outcomes will be.