I am happy to hear that. My co-author, Amy Romano, a CNM with experience in home, birth center, and hospital births, and, I should add, my supervisor for this Forum, and I are very excited about the work we're doing on the new edition and how helpful we think it will be for those advocating for or wanting to practice optimal care (defined by ACNM as care likely to produce the best outcomes in any individual case with the least use of medical intervention). We just wish we could figure out how to make it go faster.

I know what you mean about morbidity and mortality statistics. One point I make in my VBAC talk is that the excess risk of losing the baby because of a scar rupture is in the range of 1-4 per 10,000. The excess risk of pregnancy loss in women having an amniocentesis according to one review was 60 per 10,000, but nobody is arguing against doing amniocentesis on grounds of the risk. 

Seeds JW. Diagnostic mid trimester amniocentesis: how safe? Am J Obstet Gynecol 2004;191(2):607-15.

-- Henci

I suppose "as rare as hen's teeth" is too vague for your purposes. :-) A big Swiss database study reported a rate of 1 in 10,000 in women with no previous cesarean.

Rageth JC, Juzi C, Grossenbacher H. Delivery after previous cesarean: a risk evaluation. Swiss Working Group of Obstetric and Gynecologic Institutions. Obstet Gynecol 1999;93(3):332-7.

Since the study was done in Europe and published in 1999, misoprostol (Cytotec) would not have been a factor, so doubtless in countries like the U.S. where induction with Cytotec is common, rates would almost certainly be higher.

While I'm at it, let me add that I'm reviewing papers for the VBAC chapter for the new edition of Obstetric Myths Vs. Research Realities. Some of the papers are about factors associated with uterine rupture, not just the effect of prior cesarean surgery. Having a prior D&C has popped up more than once as an associated factor.

-- Henci