I am currently working on a full explanation of the actual risk associated with uterine rupture in scarred uteri, based on an analysis of multiple journal articles and reports. However, in the meantime, let me just say this. It is NOT anything close to 1 in 200 or 0.5%! There’s also a difference between ‘risk’ and ‘statistical probability’.
There was a good article in Irish Times today. However, it cited the risk of uterine rupture as about 0.5%, which is inaccurate as it extrapolates from reports conducted within hospitals to births in the home. The setting has a huge influence on these figures because Home dramatically lowers the chance of rupture; being at home removes the biggest cause: oxytocin. Conversely, being in the hospital increases the chance of rupture – it is a contributing factor. As such, the argument that I should attend hospital ‘just in case’ a uterine rupture occurs is nonsensical – it is the hospital environment that contributes to its occurrence!
I am giving a brief outline of the abstract from a medical article here. The full article can be found at this link. The results section of this reports that the chances of rupture in the absence of oxytocin are closer to either 0 (if all 13 oxytocin-exposed women were the 13 women with previous caesareans) or 2 (if not); giving a maximum risk of 0.00050492299%. This study, from The Coombe in the decade 1982 to 1991, was conducted by Dr. Michael Turner, expert witness for the HSE in my case. In his own study, there were 15 cases of uterine rupture in 65,488 deliveries, giving an overall incidence of 1 in 4,366. Of the 15 cases, only two occurred in 39,529 women who had previous children but without a previous uterine scar (1 in 19,765), and 13 cases occurred in the 3,961 women with a previous caesarean section scar (1 in 304). Ten of the 15 patients had labour induced, and a total of 13 patients received an oxytocic agent. Of the 15 cases, 8 were diagnosed during labour and 7 postpartum. [...] “This review highlights the risk of uterine rupture when an oxytocic agent is administered to a multigravid patient with a previous caesarean section scar.”
There is no chance of receiving an oxytocic agent in my home, bringing the statistical chance of a uterine rupture in my particular case to between 0% and 0.00050492299%.
Just how small do the figures have to be before it is generally considered that I am not risking the life of my child?
And even then, there’s more to demonstrate a further reduction from various influencing factors in the home. Most importantly of all though; don’t confuse the statistical probability of a rupture occurring with the statistical probability of infant mortality; one does not lead inexorably to the other … but I’ll save that for the next post.
Another study, this time in the Netherlands over a number of years, also available here. One of the really interesting parts is in the introduction, where it talks about the general international population statistical risk, and says why it is not relevant within most ‘developed’ (I hate that word) countries: http://onlinelibrary.wiley.