The topic of vaginal birth after cesarean section (aka VBAC), is in the news again. According to OB-GYN News, a recent medical study has shed some light on the dreaded VBAC complication, uterine rupture. A uterine rupture is the opening of a previous uterine scar or incision that occurs while the uterus is contracting in labor. Although rare, occurring 1 in every 5,000 to 8,000 pregnancies, its results are life-threatening and can result in significant bleeding and shock. Traditionally, a uterine rupture was difficult to diagnose with signs and symptoms presenting only after a catastrophe such as fetal death or significant bleeding. However, there is new hope in sight.
According to Dr. Lori Harper of Washington University in St. Louis, slow progression of labor after reaching 7 centimeters in women who are attempting a trial of labor after c. section (TOLAC ) may signal signs of uterine rupture. Women who have never had children dilate 1.2 centimeters per hour while women who have had previous children progress at 1.5 centimeters per hour. If a woman with a previous c. section makes progress to 7 centimeter and then her labor pattern slows down, this is a cause for concern. Labor progress is determined by how quickly the cervix dilates each hour. According to Harper, once a patient has reached 7 centimeters and the cervix is taking 10 to 13 minutes longer than expected, there is a possibility that the uterine incision might be separating, especially for patients who are being induced with a medication called Pitocin. Harper emphasizes that slow progress before 7 centimeters during (TOLAC) does not necessarily suggest a uterine rupture, but slow progress after 7 centimeters does.
Harper suggests that patients should be examined every hour as opposed to two, if their labor slows down after reaching 7 centimeters. The adoption of this protocol might improve the safety of VBACs significantly; therefore if you’re pregnant and contemplating a VBAC, please consider discussing this with your healthcare provider.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.