VBAC: Vaginal Birth After Cesarean – Complete Guide to Benefits, Risks & Success Rates

If you’ve had a cesarean section in a previous pregnancy, you may be wondering whether vaginal birth is possible for your next delivery. Vaginal birth after cesarean (VBAC) is an option that many women successfully choose, offering potential benefits over repeat cesarean delivery. Understanding the facts about VBAC can help you make an informed decision that’s right for you and your baby.

This comprehensive guide explores everything you need to know about VBAC, from success rates and benefits to potential risks and eligibility requirements. Whether you’re just beginning to consider your options or actively planning for a VBAC delivery, this information will help you have meaningful conversations with your healthcare provider.

What Is VBAC?

VBAC stands for vaginal birth after cesarean. It refers to delivering a baby vaginally after having at least one previous delivery by cesarean section. When a woman decides to attempt vaginal delivery after a prior C-section, the process is called a trial of labor after cesarean (TOLAC).

Not every TOLAC results in a successful vaginal delivery. If complications arise during labor, an emergency cesarean section may become necessary. However, many women who attempt VBAC successfully deliver their babies vaginally, avoiding the surgical procedure and recovery associated with repeat cesarean delivery.

In the United States, approximately 70% of women who attempt VBAC after one previous cesarean section succeed in having a vaginal delivery. This success rate varies based on individual circumstances and risk factors, which we’ll explore in detail throughout this guide.

The Benefits of Choosing VBAC

When successful, vaginal birth after cesarean offers several significant advantages compared to scheduled repeat cesarean delivery:

Reduced Surgical Risks

Because VBAC avoids abdominal surgery, you face lower risks of surgical complications including infection, blood loss, and damage to surrounding organs. Vaginal delivery eliminates the need for incisions through multiple layers of abdominal tissue and the uterine wall.

Faster Recovery Time

Women who deliver vaginally typically experience shorter hospital stays and faster recovery periods. Without surgical wounds to heal, most women can resume normal activities more quickly than those recovering from major abdominal surgery. This can be especially important if you have other children at home who need your care.

Lower Risk of Respiratory Issues for Baby

Babies born vaginally have lower rates of breathing problems after birth compared to those delivered by cesarean section. The process of vaginal delivery helps clear fluid from the baby’s lungs, which can reduce the likelihood of respiratory complications.

Benefits for Future Pregnancies

Each cesarean section increases the risk of complications in subsequent pregnancies. Multiple cesarean deliveries raise the chances of developing serious placental problems, including placenta accreta (where the placenta grows too deeply into the uterine wall) and placenta previa (where the placenta covers the cervix). VBAC can help you avoid accumulating scar tissue that may complicate future pregnancies and deliveries.

Shorter Hospital Stay and Lower Healthcare Costs

Vaginal deliveries generally require shorter hospitalizations than cesarean sections, which can reduce medical expenses and allow you to return home to your family sooner.

Understanding the Risks of VBAC

While VBAC offers many benefits, it’s essential to understand the potential risks involved with attempting vaginal birth after cesarean:

Uterine Rupture

The most serious risk associated with VBAC is uterine rupture, which occurs when the cesarean scar on the uterus tears open during labor. While uterine rupture is rare, occurring in less than 1% of VBAC attempts, it is a life-threatening emergency for both mother and baby.

Uterine rupture requires immediate emergency cesarean delivery. In severe cases, it may necessitate removal of the uterus (hysterectomy) to control bleeding and save the mother’s life. This would end your ability to become pregnant in the future.

Emergency Cesarean Section

If VBAC is unsuccessful and complications develop during labor, you may need an emergency cesarean section. Emergency C-sections performed after labor has begun carry higher risks than planned cesarean deliveries, including increased blood loss and infection risk.

Blood Transfusion

Women who attempt VBAC and end up requiring emergency cesarean section have a higher likelihood of needing blood transfusions compared to those who schedule planned repeat cesarean deliveries.

Infection

While successful VBAC has lower infection risks than cesarean delivery, an unsuccessful TOLAC that ends in emergency cesarean section carries a higher infection risk than either planned cesarean or successful VBAC.

It’s important to note that successful VBAC is associated with fewer complications than repeat cesarean section. However, an unsuccessful VBAC attempt that ends in emergency cesarean carries more risks than either successful VBAC or planned cesarean delivery.

Am I a Good Candidate for VBAC?

Not everyone who has had a previous cesarean section is a suitable candidate for VBAC. Your healthcare provider will evaluate multiple factors to determine whether attempting vaginal birth is safe for you:

Type of Previous Uterine Incision

The type of incision made on your uterus during your previous cesarean section is one of the most important factors in determining VBAC eligibility. Most cesarean sections use a low transverse (horizontal) incision on the lower part of the uterus. Women with this type of incision are generally good candidates for VBAC.

However, if you had a classical (vertical) incision in the upper portion of the uterus, VBAC is typically not recommended due to a significantly higher risk of uterine rupture. It’s important to note that the type of incision on your skin may differ from the incision on your uterus, so you’ll need to review your surgical records with your healthcare provider.

Number of Previous Cesarean Sections

Women who have had one previous cesarean section with a low transverse incision are usually good candidates for VBAC. Those who have had two previous cesarean sections may still be able to attempt VBAC, depending on other factors, though the risks increase slightly.

If you’ve had three or more cesarean sections, VBAC is generally not recommended due to increased risk of complications, though individual circumstances may vary.

Reason for Previous Cesarean Section

Why you needed a cesarean section in your previous pregnancy affects your chances of VBAC success. If your cesarean was performed for a non-recurring reason such as breech presentation or fetal distress, your chances of successful VBAC are higher.

However, if your previous cesarean was due to failure to progress in labor (labor dystocia) or cephalopelvic disproportion (baby too large to fit through the pelvis), your success rate may be lower, as these conditions may recur.

Previous Vaginal Deliveries

Having had at least one successful vaginal delivery either before or after your cesarean section significantly increases your chances of VBAC success. Women with a history of vaginal birth have success rates exceeding 85-90%.

Time Between Pregnancies

The interval between your previous cesarean delivery and your current pregnancy affects VBAC safety. A gap of at least 18-24 months between pregnancies allows your uterine scar to heal more completely, reducing the risk of uterine rupture. Attempting VBAC less than 18 months after a previous cesarean increases rupture risk.

Current Pregnancy Factors

Several factors related to your current pregnancy influence VBAC eligibility:

• Placental position: Placenta previa or other placental abnormalities may make vaginal delivery unsafe
• Baby’s position: Breech or transverse presentation typically requires cesarean delivery
• Multiple gestation: Carrying twins may still allow VBAC in some cases, but triplets or higher-order multiples generally require cesarean delivery
• Estimated baby size: A very large baby (macrosomia) may reduce VBAC success rates
• Gestational age: Going significantly past your due date may affect your provider’s recommendation

Other Uterine Surgery

If you’ve had other surgeries on your uterus, such as myomectomy (fibroid removal) or surgery to correct uterine abnormalities, VBAC may not be recommended. These procedures can create additional weak points in the uterine wall that increase rupture risk.

Medical Conditions

Certain medical conditions may affect your ability to safely attempt VBAC. Your healthcare provider will consider conditions such as high blood pressure, diabetes, heart disease, and other health concerns when evaluating your candidacy for vaginal birth.

Previous Uterine Rupture

If you experienced uterine rupture during a previous pregnancy, VBAC is typically not recommended due to high risk of recurrence.

VBAC Success Rates: What to Expect

Understanding success rates can help you set realistic expectations for your VBAC attempt. Overall, approximately 60-80% of women who attempt VBAC after one previous cesarean section succeed in delivering vaginally.

Factors That Increase Success Rates

Your individual success rate may be higher if you have:

• At least one previous vaginal delivery (success rate 85-90%)
• A previous cesarean for non-recurring reasons like breech presentation
• Spontaneous labor onset without induction
• A favorable cervix that is beginning to dilate and efface
• A healthy BMI (body mass index)
• Maternal age under 35
• Baby’s estimated weight under 4,000 grams (about 8 pounds, 13 ounces)

Factors That May Decrease Success Rates

Your success rate may be lower if you have:

• Previous cesarean due to failure to progress in labor
• Need for labor induction
• No previous vaginal deliveries
• Obesity or high BMI
• Baby’s estimated weight over 4,000 grams
• Maternal age over 35
• Short interval between pregnancies (less than 18-24 months)
• Pregnancy continuing past 40 weeks

Labor Induction and VBAC

Whether labor can be safely induced for women attempting VBAC is an important consideration. Labor induction involves using medications or other methods to start labor artificially before it begins on its own.

Induction of labor in VBAC candidates is more controversial than allowing spontaneous labor to begin naturally. Some methods of induction may slightly increase the risk of uterine rupture. Your healthcare provider will carefully weigh the risks and benefits of induction based on your specific situation.

If induction is medically necessary, your provider will discuss the safest methods and closely monitor you and your baby throughout the process. However, many providers recommend that women attempting VBAC wait for spontaneous labor when possible, as this is associated with higher success rates and lower complication risks.

What to Expect During VBAC Labor and Delivery

If you decide to attempt VBAC, your labor and delivery experience will be similar to any vaginal birth in many ways, but with some important differences:

Hospital Setting Required

VBAC must be performed in a hospital or birth center with immediate access to emergency cesarean section capabilities. Home birth is not safe for VBAC attempts due to the risk of uterine rupture requiring emergency surgery. The facility should have surgical and anesthesia staff available 24/7.

Continuous Fetal Monitoring

During VBAC labor, your baby’s heart rate will likely be monitored continuously using electronic fetal monitoring. This allows your healthcare team to quickly identify signs of fetal distress that could indicate uterine rupture or other complications.

Intravenous (IV) Access

You’ll likely have an IV line placed when you arrive at the hospital, even if you don’t need immediate IV fluids or medications. This ensures quick access if emergency treatment becomes necessary.

Signs of Uterine Rupture

Your healthcare team will watch for warning signs of potential uterine rupture, including:

• Abnormal fetal heart rate patterns
• Sudden severe abdominal pain
• Vaginal bleeding
• Loss of contraction strength
• Maternal low blood pressure or rapid heart rate

Pain Management Options

You can use the same pain management options available for any vaginal delivery, including epidural anesthesia, which does not increase the risk of uterine rupture. In fact, having an epidural already in place can be advantageous if emergency cesarean section becomes necessary.

Ready Access to Emergency Cesarean

Throughout your labor, the surgical team will be prepared to perform an emergency cesarean section within minutes if complications arise. This quick response capability is essential for managing uterine rupture or other emergencies.

After Successful VBAC

If your VBAC is successful, your recovery will be similar to any vaginal delivery. You’ll likely stay in the hospital for 24-48 hours and can usually resume normal activities within a few weeks. Your healthcare provider will examine your uterus after delivery to ensure no complications occurred.

Preparing for Your VBAC Attempt

Adequate preparation can improve your chances of a successful VBAC experience:

Early Discussion with Your Healthcare Provider

Begin talking with your healthcare provider about VBAC early in your pregnancy, ideally during your first prenatal visit. This allows time to gather your previous medical records, evaluate your candidacy, and develop a birth plan.

Obtain Complete Medical Records

Request detailed records from your previous cesarean delivery, including the operative report that describes the type of uterine incision used. This information is crucial for determining whether VBAC is safe for you.

Choose the Right Healthcare Provider and Facility

Not all healthcare providers or birthing facilities support VBAC. Ensure your provider is experienced with VBAC and delivers at a hospital equipped for emergency cesarean section. Ask about their VBAC success rates and policies.

Take Childbirth Education Classes

Consider taking childbirth classes specifically designed for VBAC candidates. These classes can teach you about the labor process, pain management techniques, and what to expect during a VBAC attempt.

Develop a Birth Plan

Create a flexible birth plan that outlines your preferences for labor and delivery while acknowledging that circumstances may require deviation from the plan. Discuss your plan with your healthcare provider and make sure it’s realistic for VBAC.

Maintain Healthy Lifestyle Habits

Maintaining a healthy weight, eating nutritious foods, and staying physically active during pregnancy can improve your chances of VBAC success. Consult your healthcare provider before starting any exercise program.

Build a Support System

Surround yourself with supportive family members, friends, or a doula who understand your desire for VBAC and can provide emotional encouragement throughout pregnancy and labor.

Stay Flexible and Informed

While it’s good to work toward VBAC, remain flexible and open to the possibility that circumstances may change. Understanding that the goal is a healthy delivery for you and your baby, regardless of method, can help reduce anxiety and disappointment if cesarean section becomes necessary.

VBAC vs. Repeat Cesarean Section: Making Your Decision

Deciding between attempting VBAC and scheduling a repeat cesarean section is deeply personal. Both options have benefits and risks that you should carefully consider with your healthcare provider.

Questions to Ask Your Healthcare Provider

• Based on my medical history, what are my chances of successful VBAC?
• What specific risks do I face with VBAC versus repeat cesarean?
• What is your experience with VBAC deliveries?
• What is the VBAC success rate at your hospital?
• What resources are available at your hospital for emergency situations?
• How will my labor be monitored during a VBAC attempt?
• At what point during labor would we decide to proceed with cesarean section?
• If I plan VBAC but need emergency cesarean, what are the implications for future pregnancies?
• How do you feel about my desire for VBAC?

Factors to Consider in Your Decision

• Your personal preferences and values regarding birth experience
• Your plans for future pregnancies
• Your individual medical history and risk factors
• The policies and capabilities of available birthing facilities in your area
• The support and experience level of your healthcare provider
• Your ability to accept either outcome (vaginal or cesarean)
• Recovery time considerations based on your life circumstances

Common Myths and Misconceptions About VBAC

Myth: “Once a cesarean, always a cesarean”

This outdated saying is no longer considered accurate medical advice. Many women can safely deliver vaginally after one or even two previous cesarean sections, depending on individual circumstances.

Myth: VBAC is too dangerous to attempt

While VBAC carries some risks, successful VBAC is actually safer than repeat cesarean section for most women. The key is proper candidate selection and monitoring during labor.

Myth: You can’t have an epidural during VBAC

Epidural anesthesia is safe during VBAC and does not increase the risk of uterine rupture. Having an epidural can actually be beneficial if emergency cesarean becomes necessary.

Myth: VBAC after two cesareans is impossible

While VBAC after multiple cesareans carries slightly higher risks, it may still be possible for carefully selected candidates under close medical supervision.

Myth: Labor cannot be induced for VBAC

While spontaneous labor is preferred, induction may be performed for VBAC candidates when medically necessary, using careful methods and close monitoring.

When VBAC May Not Be Recommended

Despite the benefits of VBAC, there are situations where repeat cesarean section is the safer choice:

• Previous classical (vertical) uterine incision
• Previous uterine rupture
• Previous extensive uterine surgery
• Uterine abnormalities or weak areas in the uterine wall
• Placenta previa or other placental complications
• Baby in breech or transverse position
• Triplets or higher-order multiples
• Delivery at a facility without emergency cesarean capabilities
• Medical conditions that make labor unsafe
• Contracted pelvis or other anatomical factors preventing vaginal delivery

Life After VBAC: Future Pregnancy Considerations

Whether your VBAC attempt is successful or not will influence future pregnancy planning:

After Successful VBAC

If you successfully deliver vaginally, you have excellent prospects for vaginal delivery in future pregnancies. Having one VBAC significantly increases your chances of success in subsequent VBAC attempts. You’ll also avoid accumulating additional uterine scars that could complicate future pregnancies.

After Unsuccessful VBAC

If you attempt VBAC but require cesarean section during labor, you’ll have two cesarean scars on your uterus. This increases risks for future pregnancies, including placental complications. However, depending on why the VBAC was unsuccessful and other factors, you may still be able to attempt VBAC in a future pregnancy. Discuss your options with your healthcare provider.

Planning Future Pregnancies

Regardless of outcome, wait at least 18-24 months before becoming pregnant again to allow your body adequate time to heal and reduce risks in the next pregnancy.

Conclusion: Making an Informed Choice About VBAC

Vaginal birth after cesarean is a safe and viable option for many women who have had previous cesarean deliveries. With approximately 70% of VBAC attempts resulting in successful vaginal delivery, many women can avoid repeat surgery and experience the benefits of vaginal birth.

However, VBAC is not right for everyone. The decision requires careful evaluation of your individual medical history, current pregnancy factors, and personal preferences. Working closely with an experienced healthcare provider who supports VBAC and delivers at an appropriately equipped facility is essential for safety and success.

Whether you ultimately choose to attempt VBAC or schedule a repeat cesarean section, the most important factor is making an informed decision that feels right for you and gives you and your baby the best chance for a healthy outcome. Stay informed, ask questions, remain flexible, and trust that you and your healthcare team will make the best decision for your unique situation.

Remember that regardless of how your baby is born, what matters most is that you and your baby are healthy and safe. Whether through vaginal delivery or cesarean section, you’re bringing new life into the world, and that’s something to celebrate.

Sources:

• American College of Obstetricians and Gynecologists – Vaginal Birth After Cesarean Delivery
• Mayo Clinic – VBAC: Know the Pros and Cons
• National Institute of Child Health and Human Development – Vaginal Birth After Cesarean
• MedlinePlus – Vaginal Birth After C-section
• March of Dimes – Vaginal Birth After Cesarean