Ruptured: The Unseen Forces at Play in Our Bodies

Uterine rupture is a catastrophic event with significant consequences

One day old

It was a long labor—on and off for three agonizing days.

“It’s ripping, it’s ripping,” I cried, my voice trembling with fear and pain.

“No, those are contractions,” he said dismissively. “You just don’t know what they feel like,” arrogantly rejecting the notion that my pain could be anything other than uterine contractions.

I certainly do know what they feel like. I’ve had them before. You, on the other hand, could never have had a contraction. I thought, “How could you possibly know?” My mind was racing with frustration and helplessness.

“Doctor, I’m telling you something is wrong. This pain is not contractions. It’s different. It doesn’t feel like the intense muscle cramping of any contraction I’ve ever had. It’s not stopping. Contractions come in waves; this is continuous. It feels like tearing and ripping, and I have no control,” I thought in a silent scream.

Those are all the things I wanted to say, but I was too drained and exhausted after hours of active labor, enhanced by a Pitocin drip. My voice discarded; I could only think these thoughts, and the only words I could eke out were, “It’s not stopping.”

I’m so exhausted now… so tired… want to sleep. No longer able to hold up my own weight, I lay back—dismissed, tired, fading into a haze of pain and fear.

A sea of green scrubs suddenly surrounded my bed, swiftly wheeling me to the operating room for an emergency cesarean section. My baby’s heart rate dipped and wasn’t returning, while my blood pressure rapidly fell—a creeping dread wrapped around my heart.

Before the anesthesia took hold, I felt the burn of the cold, sharp scalpel across my lower abdomen as it cut through my skin and muscle. Unable to respond, the pain washed over me, but I didn’t care—I knew they had to act fast to save my baby.

When the surgeon opened my abdomen, he found my baby lying in my abdominal cavity. Instead of pushing her through the birth canal and out into the world, I birthed her into my abdomen. My uterus had ruptured during labor contractions, ripping open a previous cesarean scar, creating an alternative exit.

As she took her first breath, her little lungs filled with the blood that was flooding my abdomen instead of oxygen-rich air. The neonatologist quickly intubated her, suctioning out all the blood from her lungs, making room for air in its place. Her limp blue body quickly pinkened as the oxygen revived her.

The moments after were a blur—a whirlwind of frantic movements, urgent voices, and the bloody smell of the operating room. My consciousness drifted in and out, caught between the grip of exhaustion and the hope that everything was okay.

As I recovered, the world slowly became focused, and I felt a strange mix of emptiness and relief. My body ached, but the pain was secondary to the yearning to see my baby.

“Thank you for saving her,” I whispered, my voice barely audible, a fragile thread of hope amongst the overwhelm.

“It wasn’t me,” the surgeon said. “You have someone up there looking out for you.” Of that, he was certain and refused to take credit.

The fear and anxiety that had gripped me released. In that moment, nothing else mattered. We had both survived against poor odds. My baby girl was alive. She was a fighter.

Despite the trauma, despite the pain, we had made it through. The bond between us was forged in the crucible of that harrowing experience. We had been given a second chance—a gift I would cherish forever.

Recently, while celebrating my daughter’s twenty-ninth birthday, I was reminded of the unseen forces always at play in our lives. The surgeon’s words still echo in my mind:

Someone is watching over you.

I remain grateful that a routine shift change replaced the first doctor whose care I was under. Given that he was too full of his own authority to listen to his patient, I don’t know what the outcome would have been. It’s incredible what a difference a caring, compassionate approach can make.

And I am forever grateful for my labor nurse, who immediately recognized and acted on the first signs of fetal distress. Her skilled and swift response saved us.

In quiet moments, I deeply appreciate the interconnectedness of faith, health, and the precious moments that define our existence.

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Uterine Rupture

In 1995, insurance companies promoted VBAC (Vaginal Birth After Cesarean) due to the lower costs associated with vaginal deliveries compared to cesarean sections. Prior to this shift, the prevailing practice in obstetric medicine was, "Once a C-section, always a C-section."

“Uterine rupture is defined as complete disruption of all uterine layers during pregnancy, delivery, or immediately after delivery. It is a catastrophic situation in obstetrics, and, although rare, often results in both maternal and fetal adverse consequences.”

J Matern Fetal Neonatal Med.

Uterine rupture carries a high rate of maternal and perinatal morbidity and mortality. Attempting a vaginal birth after a previous cesarean involves multiple major risk factors for uterine rupture, which are beyond the scope of this essay.

Women using epidural analgesia are at an increased risk of uterine rupture. The correlation between epidural analgesia, the use of prostaglandins and synthetic oxytocin such as Pitocin, and the incidence of uterine rupture requires further investigation and restraint in future use.

The crucial question remains: Should we allow insurance companies, governments, and pharmaceutical companies to dictate medical practices? As a nurse at the time, I believed I was well-informed. I consulted with my doctor, whom I trusted to follow best practices. However, in hindsight, it became clear that decisions were heavily influenced by the insurance companies that ultimately paid the physicians and hospitals. This highlights the numerous conflicts of interest in the medical field that remain to this day.

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References:

Barger MK, Weiss J, Nannini A, Werler M, Heeren T, Stubblefield PG. Risk factors for uterine rupture among women who attempt a vaginal birth after a previous cesarean: a case-control study. J Reprod Med. 2011 Jul-Aug;56(7-8):313-20. PMID: 21838161.

Figueiró-Filho EA, Gomez JM, Farine D. Risk Factors Associated with Uterine Rupture and Dehiscence: A Cross-Sectional Canadian Study. Rev Bras Ginecol Obstet. 2021 Nov;43(11):820-825. doi: 10.1055/s-0041-1739461. Epub 2021 Dec 6. PMID: 34872139; PMCID: PMC10183935.