This was my second pregnancy; my first had ended in caesarean after being induced and 16 hours of labour. My consultant informed me that I had to go for a trial by labour in the second pregnancy. This scared me as I had heard a lot about uterine rupture and my scar was only 5 months old when becoming pregnant again. The consultant re-assured me that I would be monitored throughout the labour; however there could be no special monitoring that they could do to detect a uterine rupture. He stated I would not be allowed to labour too long. I felt calmer.
I went into hospital at 8pm when my contractions started getting stronger. When I was checked out I was only 2.5 cm dilated. I was coping with the pain - but I informed the Midwife my pain was mainly within the scar region. This was perfectly normal according to the medical staff. I was not given pain killers because this would effect my progress.
I had been told that I would be monitored through a foetal monitor at my 12 week consultation, but I had tested positive for GBS (Group B streptococcus) a month earlier and had to be given antibiotics at time of birth to ensure no infection was transferred to the baby. This meant they were unwilling to break my waters in order to give the antibiotics a chance to be passed to the baby - so no foetal scalp electrode was used.
At 23.50 no real progression had been made, and I was allowed to have Diamorphine - at which point my contractions tailed off.
At 3.30 membranes were ruptured and I was 4-5 cm dilated. I was given an epidural on request. Even though my husband and I started a conversation on what a uterine rupture was and what were the effects, sytocinon was started - but no associated risks were explained to me. Sytocinon is a drug used to increase contractions, but places a stress on the uterus because the labour is being artificially encouraged.
By 7am the registrar was due to see me but was in surgery. My sytocinon levels were altered and I was 7 cm dilated. I was contracting too fast so my Sytocinon levels were altered up and down a number of times to get it right, increasing the levels of stress felt by the uterus. I told the midwife that contractions felt weird around my c-section scar; to one side the contractions seemed to continue longer and be stronger.
Before I saw a consultant at 8.50am it was noted that I was feeling cold and shivery. The consultant observed that progress was slow, and I should be examined again at 9.30. Then it all heated up. They lost the baby's heart beat on the monitor at 9.32 - when they turned me over to regain a trace, I felt the most excruciating pain ever. The registrar was called for and after his internal examination it was obvious that I had ruptured. He could no longer find the baby's head, blood was everywhere, I was extremely cold, had uncontrollable shakes and my cervix was 3cm again. I went to surgery and had a general anaesthetic.
Unfortunately the wrong anaesthetist was called and the emergency caesarean took 38 minutes from being prescribed. Usually a c-section takes 15 minutes. My son was totally within my abdomen. The placenta had shut down and the uterus was contracting to a normal size. My LSCS had completely given way. I lost 1.5 litres of blood.
Matthew was born with an AGPAR of 1. After 5 minutes this had raised to 4. He was intubated and taken to Neo-Natal care. Tubes of every nature were placed within him. After 9 days intensive care he was home with us. He is still seeing a consultant every 6 months for developmental checks. It can take years to confirm that the child is healthy.
My story is not the best, but it is not the worst case scenario - deaths of mother and baby have been known (mainly in the third world) and I didn't require a hysterectomy. Emotionally it was hard, and I felt we never really celebrated Matts birth because for a number of days it was hit or miss as to his status.
But it should be noted that Uterine ruptures only happen about 1 in 250 VBAC cases, and the degrees of rupture differ from mild with no real effect to mother and baby to very severe. It should also be mentioned that there is no published research on how uterine ruptures occur or indeed what the symptoms are and who is more likely to be a candidate for it. There is even debate in the medical community as to what classifies as a uterine rupture. All consultants operate differently with guidelines as when to intervene in these cases depending on local health authority rules, as do midwives. What the registrar tells you at a week 12 or 20 checkups may not be written up in notes, and not carried out at labour.
In retrospect I felt I laboured too long - 14 hours from start of contractions to go 7 cm - but I never questioned the information. I never checked up on Sytocinon and its effects, never knew the risks and they don't always tell you. Alas it is up to the patient to check up on these things and fight your corner. I trusted my care staff, and was not warned of the associated dangers of certain actions. If I had done my homework, or stood my corner when describing the extra pain around my scar maybe Matt wouldn't have had the hard start in life that he did. The onus is on you.
The hospital I attended had merged maternity units 5 weeks before the birth and they were still unorganised - to the extent that staff did not known how to use machinery (they could not change over the morphine dose machine attached to me), paper work between the two hospitals had not been explained to the staff and even breast pumps were unavailable. If this is happening where you are due to give birth check what they have done in preparing for emergencies - because of the merger the wrong anaesthetist was called. It made for a very unpleasant experience of after care service, I felt very left alone by the midwives at a time of emotional and physical turmoil.
I know all this sounds serious and it is, but as I said it turns out better or worse for some - Matt is healthy, smiley and a huge baby, hitting all his developmental targets. I think he will be fine, but there are cases were the patient is not fine. If you are worried shout out while in labour, it will cause less harm in the long run if you state anything that doesn't feel right, than realise you should have done this later.
My Top Tips to avoid rupture (or at least know what your consultant is thinking)