The Risks of Uterine Rupture During VBAC or HBAC and How to Reduce Them

Perhaps the biggest fear we have in our community and the reason we all are often talked into having another Cesarean by OBs and midwives during VBAC or HBAC preparation is uterine rupture.

Statistically, uterine rupture happens in 0.4% -1% of TOLAC (Motomura, 2017). That equates to one in 240 women. To put that into perspective, we all have a 1 in 160 chance of having a heart attack each year (CDC, NCHS, 2015) and 1 in 160 chance of being audited by the IRS (Heath, 2018).

However, there are many things you can do to help minimize the chances of uterine rupture. It is important to discuss these things with your provider (learn more about how to find a supportive provider in our How to VBAC Course for Parents here) and have a solid plan ready if any interventions are necessary.

• Try and avoid induction unless absolutely necessary (we discuss the best induction methods for VBAC here)
• Avoid augmentation of labor if possible (something to stimulate contractions, usually Pitocin)
• If Pitocin is part of your labor, avoid excessively upping the dose too fast
• Avoid Cytotec (misoprostol) COMPLETELY
• Avoid choosing a provider who aggressively intervenes with and manages labor
• Stay mobile. Walk, change positions and posture when in active labor
• In early labor and if labor stalls, rest or sleep vs trying to push labor along
• Do EVERYTHING you can to make sure your baby is in the most optimal position BEFORE labor begins (We talk a lot about this during our How to VBAC course – this is so important!)
• Avoid rupturing membranes (aka having your water broken) if the baby is not in an optimal position (you can ask your provider or if you really feel it’s necessary you can get an ultrasound to see if they can confirm baby’s position. Allowing our water to break naturally is most ideal. Water is a lubricant that lets baby get into the most optimal position during labor)
• Have attentive labor support with you ALL THE TIME – aka try to hire VBAC Trained doula​
• Be aware of typical labor patterns. Any stalls in labor are usually indicative that something needs to change (emotional processing, baby position, rest/sleep, and even Pitocin in some instances). Figure out what needs to change and fix it if you can. A long stall combined with high doses of Pitocin may be a prime scenario for uterine rupture.
• HONOR YOUR INTUITION. If you feel that something is not quite right or if the baby’s movement is significantly decreased, insist that your provider or their staff pay attention to you. In many instances, uterine rupture occurs when a mother knows something is wrong immediately before providers pay enough attention.

I hope this information helps you if you are continuously thinking about uterine rupture. If you want to learn more about it and learn how to work through your fears of uterine rupture, consider taking our How to VBAC Course for Parents or join our VBAC Doula Training to learn how to support VBAC parents through uterine rupture fears, to notice signs of it occurring and what to do.