VBAC: Dangers To The Mother

Most of what is written about a trial of labor after cesarean focuses on the baby. That focus is understandable. But a uterine rupture is dangerous to the mother as well. Some women come through a rupture having suffered serious, permanent harm of their own, including heavy blood loss, surgery they never expected, and the loss of the ability to have more children. If that happened to you, your injuries matter, and they deserve to be taken seriously.

This page explains the harm a uterine rupture can do to a mother, the care she is owed, and how a family can find out whether that harm could have been prevented.

What a uterine rupture does to the mother

A trial of labor after cesarean, often called TOLAC, carries the risk that the old cesarean scar on the uterus will tear during labor. This is a uterine rupture.

When the uterine wall tears, the consequences for the mother can be severe. The uterus has a rich blood supply, so a rupture can cause heavy and rapid bleeding. That blood loss can become dangerous quickly. The tear can also extend into nearby structures, including the bladder. To control the bleeding and repair the damage, surgeons must operate at once.

The injuries a mother can suffer

The maternal harm from a uterine rupture can take several forms. Some women experience one of these injuries. Others experience several.

1. Severe hemorrhage, meaning dangerous blood loss that may require transfusion.
2. Hysterectomy, the surgical removal of the uterus, sometimes performed as the only way to stop the bleeding.
3. Injury to the bladder or other nearby organs.
4. The loss of the ability to carry another pregnancy.
5. The physical toll of emergency surgery and a long, difficult recovery.
6. Lasting emotional trauma from a delivery that became life-threatening.

The loss of fertility deserves its own mention. For a woman who hoped to have more children, a hysterectomy performed during a rupture emergency closes that door permanently. That is a profound loss, and it is a real and compensable injury.

The care a mother is owed

A rupture is an emergency for the mother just as much as for the baby. The standard of care does not stop once the baby has been delivered.

A mother in this situation is owed prompt recognition of her bleeding, fast surgical control of the source, and appropriate replacement of the blood she has lost. Her blood pressure, heart rate, and blood counts must be watched closely. When a hysterectomy becomes necessary, it should be performed competently and only when truly required to save her life or stop uncontrollable bleeding. A team that loses track of a mother’s deteriorating condition, or is slow to control her hemorrhage, can deepen an injury that better care would have limited.

Where care goes wrong

In birth injury cases involving a rupture, the mother’s care is examined alongside the baby’s. The questions overlap with the questions about the baby, because the same failures often harm both.

We look at whether the rupture should have been foreseen and prevented, including whether the mother was a proper candidate for a trial of labor and whether her labor was managed safely. We look at whether her bleeding was recognized and controlled quickly. We look at whether she received the blood she needed in time. And we look at whether a hysterectomy was genuinely unavoidable, or whether better and faster care could have saved her uterus. When a mother loses her fertility because a foreseeable emergency was handled poorly, that is a serious matter.