I am considering having a baby with my new husband, which means a lot of research for me as a 38-year old with 2 previous c-sections behind me and I will only consider having a VBAC (vaginal birth after caesarean), preferably a HBAC or homebirth. My incisions were classical, meaning long and vertical and not low and transverse, or horizontal, as most are today. It has been about 13 years since the last c-section.
Here I will compile the beginnings of my findings on uterine rupture rates for incisions like mine, of classical c-sections. This is what comes to light through a cursory search, but I will add more as I find it.
As frightening as this sounds, we know through medical research that uterine scar breakdowns (and especially uterine ruptures) are relatively uncommon events, occurring in 5-12% of classical incisions and 1/2 of 1% of low-transverse incisions.
http://home.cfl.rr.com/dahmd/vbac.htm
by D. Ashley Hill, MD,
OBGYN.net Editorial Advisor,
Associate Director – Department of Obstetrics and Gynecology,
Florida Hospital Family Practice Residency, Orlando, Florida
Prior classical uterine incision is associated with a rate of uterine rupture of up to 12%.
http://www.phyins.com/pi/risk/minimize/vbacs.html
Classic cesarean delivery is infrequently performed in the modern era and currently account for 0.5% of all births in the United States (Chauhan, 2002). In a meta-analysis, Rosen et al (1991) reported an 11.5% absolute risk of uterine rupture (3 of 26 cases) in women with classic vertical cesarean scars who underwent an unplanned TOL. Chauhan et al (2002) reported that the uterine rupture rate for 157 women with classic uterine cesarean scars was 0.64% (95% CI, 0.1-3.5%). All patients underwent repeat cesarean delivery, but a high rate of preterm labor resulted in 49% of the patients being in labor at the time of their cesarean delivery.
Landon et al (2004) reported a 1.9% absolute uterine rupture rate (2 of 105 cases) in women with a previous classic, inverted T, or J incision who either presented in advanced labor or who refused repeat cesarean delivery. These rates of frank uterine rupture in women with classic cesarean deliveries are in contrast to the higher rates of 4-9% that the American College of Obstetricians and Gynecologists (ACOG) had historically reported for women with these types of uterine scars. However, Chauhan et al (2002) observed a 9% rate of asymptomatic uterine scar dehiscence (95% CI, 5-15%). This result suggests that disruptions of uterine scars might have been misclassified as true ruptures instead of dehiscences in previous studies; this error may explain the bulk of the discrepancy.
http://www.emedicine.com/med/topic3746.htm
(Australian VBAC study) Major uterine rupture, before or during labour, after a classical Caesarean section is 5%.
http://www.birthrites.org/guidelines.html
On the other hand, Midwifery Today:
There are a number of contraindications to VBACs that the vast majority of obstetricians and most midwives agree on. Most of these involve significantly higher risks to mother and baby due to increased rates of uterine rupture. There are, of course, anecdotes of successful VBACs in these situations, but the statistics reveal accelerated risks.
These situations include: classical (vertical) scar on the uterus, T- or J-incision on the uterus, previous surgery through the full thickness of the uterine muscle (example, myomectomy), truly contracted or deformed pelvis, inability to perform an emergency cesarean delivery if needed, obstetrical complications that preclude vaginal delivery (example, placenta previa), and a woman’s refusal to have a Trial of Labor/VBAC.
http://www.midwiferytoday.com/articles/vbacprimer.asp
