·       Vaginal birth is safer for mothers in most cases. Numerous studies have conclusively shown that elective repeat cesarean is more hazardous for the woman, no safer for the baby, and poses serious risks to the woman's future reproductive life.

 

·     The risk of uterine rupture associated with women who have had a previous cesarean with a low transverse incision are as follows: 0.16% (or 16 of every 10,000) with repeat elective cesarean, 0.54% (or 54 of every 10,000 women) with spontaneous onset of labor, 0.77% with inductions NOT involving prostaglandins (or 77 of every 10,000), and 2.45% with inductions involving prostaglandins (or 245 of every 10,000).

 

·     In many reported series, true uterine rupture has not been distinguished from uterine scar dehiscence. Bloodless uterine scar dehiscence does not have negative consequences for mother or baby, whereas complete rupture of the uterus can be a life-threatening emergency. Fortunately the true rupture is rare in modern obstetrics, despite the increase in cesarean section rates.

 

·     Although often considered to be the most common cause of uterine rupture, previous cesarean section is a factor in less than half the reported cases.

 

·     Prompt detection is crucial for timely management of uterine rupture. Clinical symptoms such as sudden tearing uterine pain, vaginal hemorrhage, cessation of uterine contractions, and regression of the fetus have proven to be unreliable and often absent. Fetal distress has been found to be the most reliable presenting clinical symptom.

 

·     Maternal death is a rare complication of rupture, though it is more common in ruptures occurring outside of a hospital and in women with an unscarred uterus. Neonatal outcome after uterine rupture depend largely on the speed with which surgical rescue is carried out. In one study, best outcomes were noted when surgical delivery was accomplished within 17 minutes from the onset of fetal distress on electronic fetal heart rate monitors.

 

·     If a hospital isn't safe for a VBAC labor, it isn't safe for any woman to labor there. Emergencies occur in non-VBAC labors, including uterine rupture, and there are other situations that increase the chances of needing an emergency cesarean where hospitals don't make special exceptions, such as induction of labor and epidural analgesia.

 

·     It is a violation of the rights of the childbearing women to deny vaginal birth. The Informed Refusal statement issued by the American College of Obstetricians and Gynecologist in 2000 states, “Once a patient has been informed of the material risks and benefits involved with a treatment, test, or procedure, that patient has the right to exercise full autonomy in deciding whether to undergo the treatment, test, or procedure or whether to make a choice among a variety of treatments, tests, or procedures. In the exercise of that autonomy, the informed patient also has the right to refuse to undergo any of these treatments, tests, or procedures. . . . Performing an operative procedure on a patient without the patient's permission can constitute 'battery' under common law. In most circumstances this is a criminal act. . . . Such a refusal may be based on religious beliefs, personal preference, or comfort.”

 

      This information was prepared by ICAN of Colorado and collected from several reliable and well-respected sources, including the American Journal of Obstetrics and Gynecology and the New England Journal of Medicine.

 

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