The chances of uterine rupture are small with a VBAC (0.3% to 0.7%), even less so if the woman is not given drugs to
induce or
augment the labour to stimulate contractions. It is argued that the chances of any major medical emergency happening are similar for women planning a VBAC as it is for any other healthy labouring woman.
If the uterus does rupture it can be life threatening, usually more so for the baby, than for the woman. For this reason the medical recommendation is generally that women planning a VBAC should labour and birth within a hospital that has 24 hour emergency facilities with a doctor and anaesthetist
ON SITE (not 'on call' away from the hospital), so if necessary, a Caesarean can be performed within 15 to 20 minutes of the rupture occurring.
In this light, it could be argued that 24 hour emergency facilities should be available in ALL hospitals caring for pregnant women in labour, but in reality this is not always the case. On the whole the majority of medical emergencies rarely occur rapidly, with normally plenty of time to transfer the woman to hospital or call doctors in for help if needed.
For women planning a VBAC in some private hospitals, a small public or rural hospital, a freestanding birth centre (not attached to a major hospital), or at a home for a home birth, being aware of this small possibility may prompt you to reconsider your birthplace arrangements. (Although, you may still decide not to change them as the risks are rather small).
Ask your caregiver about the emergency arrangements at your birthplace. Discuss the realistic time frame that it would take to transfer you to a hospital that can perform a Caesarean rapidly at any time of the day, any day of the week. If the doctors and anaesthetists are not onsite, ask how long will it take them to come into the hospital if necessary. If you feel uncomfortable with these arrangements, consider changing birthplaces (if this is possible).