If you’ve had a C-section in the past, you might still be able to have a vaginal birth in the future. It’s a myth that once you’ve had a C-section, you’ll need to have one for every future birth.
There are many benefits to a vaginal birth, but at the same time, there are risks that can come with attempting a vaginal birth after cesarean (also known as a VBAC). Your birth team will carefully weigh the risks and benefits to decide the best and safest option for both you and your baby.
One risk is that women with certain types of C-section scars may not be good candidates for a VBAC because they have an increased risk of uterine rupture.
What is uterine rupture?
Uterine rupture occurs when a weakened spot on the uterine wall — usually along the scar line of a previous surgery, such as a C-section — tears due to the strain put on it during a contraction.[1]
A rupture can also occur along the scar line of a myomectomy: a surgery to remove uterine fibroids (i.e. growths in the uterus).
How common is uterine rupture?
Fortunately, uterine rupture is rare. Among women who are attempting a VBAC[2] with one previous low-transverse C-section, the chances of having uterine rupture are fewer than 1 in 100.
The type of incision on the uterus, the number of C-sections previously performed, the need for labor induction, and a history of other uterine surgeries will lead to increased risk.
The odds of a spontaneous uterine rupture, among women without uterine scars, for example, are extremely rare — by some counts, about 1 in 17,000.
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What are the symptoms of uterine rupture?
Uterine rupture often occurs with no warning. Common signs of uterine rupture include:
Searing abdominal pain — a sensation that something is “ripping” — followed by diffuse pain and tenderness in the abdomen and shoulders or upper back during labor. This pain can be felt even if you’ve had an epidural.
Vaginal bleeding
A drop in blood pressure
An increased heart rate
Dizziness
Shortness of breath
A change in the fetal heart rate pattern – this is the most common sign, happening in 70 percent of cases. That’s why most hospitals require continuous monitoring during a VBAC to allow for accurate and close assessment of this risk.
Some women, however, won’t notice any symptoms of uterine rupture.
Who is most at risk of uterine rupture?
Any woman who’s had a previous C-section or uterine surgery is at increased risk because of the uterine scar that could weaken and rupture. Some uterine scars, however, are more likely to rupture during a vaginal labor than others.
- A high vertical (or “classical”) scar carries the highest risk of uterine rupture. This type of cut, which runs up and down, is made in the upper part of the uterus, sometimes for C-sections in preemie babies. Fibroid surgery tends to have vertical cuts too.
- A low transverse scar has the lowest chance of rupturing during a delivery. It's a side-to-side cut across the lower, thinner part of the uterus, and the most common type of C-section scar.
- A low vertical scar is an up-and-down cut that’s made in the lower part of the uterus. With a low vertical cut, the risk of uterine rupture is higher than that of a low transverse scar, but lower than that of a high vertical scar.
You won’t be able to tell what type of incision was made during your C-section simply by looking at your scar. Instead, you’ll need to ask your doctor or consult your medical records.
Inducing labor with prostaglandins or oxytocin (Pitocin) also increases the risk of uterine rupture.
What are potential complications of uterine rupture?
The placenta could separate from the wall of the uterus during a uterine rupture, which would cut off your baby's oxygen flow and put your little one’s life at risk if she isn’t delivered in time. This is very rare, though, and in most cases your baby will be fine if there's a uterine rupture.
Uterine rupture can also result in uncontrolled bleeding into your abdomen. It can be life-threatening if it’s not treated quickly.
How is uterine rupture treated?
If you do have a uterine rupture, you’ll have a C-section right away, followed by a surgical repair of the uterus. You may need to be given antibiotics to prevent infection. In rare cases, you also may need to have a hysterectomy (the surgical removal of the uterus).
How can you prevent uterine rupture?
Uterine ruptures cannot be prevented once labor starts – the only way to prevent them is to schedule your C-section before labor starts. If you had a previous C-section or abdominal surgery in which the uterine wall was cut through completely, you’ll want to weigh your risks when considering your labor options, especially if you want to attempt a vaginal birth. Your baby will also likely be monitored with a fetal monitor during delivery.
Many women are excellent candidates for VBAC. In general, if you’ve had one C-section and a low transverse scar, it’s possible that you might be a candidate for a VBAC. Unfortunately, some women — for example, those who have had a high-vertical scar or a rupture in the past — would not be considered good candidates, and the safest choice would be a C-section.
If you want to explore having a VBAC, talk to your health care provider about the risks and benefits to see what your options are.
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