Many women who have had a cesarean section (C-section) for a previous birth wonder if they can deliver their next baby vaginally. This is an important discussion to have with your healthcare provider early in your pregnancy. Here are some quick answers to common questions about vaginal birth after cesarean (VBAC):
Can I try for a VBAC?
In most cases, yes. Many women are candidates for VBAC, but your doctor will help determine if it may be an option for you based on several factors. These include the type of uterine incision from your previous C-section, the reason you needed a prior C-section, and any pregnancy complications.
What are the benefits of a VBAC?
Benefits of a successful VBAC include:
- Avoiding major abdominal surgery
- Lower risk of infection
- Shorter hospital stay
- Easier recovery
- Greater chance of vaginal delivery in future pregnancies
What are the risks of VBAC?
There are risks to consider with a VBAC attempt including:
- Uterine rupture – rare but serious complication when the scar from a prior C-section splits open. Emergency C-section is needed.
- Uterine dehiscence – milder splitting along the scar line. Usually resolves with rest.
- Need for unplanned C-section – if labor stalls or there are signs of fetal distress
- Higher chance of blood transfusion or infection compared to planned repeat C-section
What factors increase VBAC success?
You may have a better chance of delivering vaginally if:
- You’ve had a vaginal birth before
- Your prior C-section was for breech positioning or non-recurring issue
- You go into labor spontaneously before your due date
- You have an obstetrician and hospital equipped for emergency C-section if needed
Can I attempt VBAC after multiple C-sections?
VBAC is less common after multiple cesarean deliveries, but may still be possible depending on your unique history. Studies show the success rate falls to around 40-45% after two C-sections. Talk to your doctor about whether VBAC may be an option for you.
Conclusion
For most women, attempting a VBAC is a reasonable and safe choice after a prior low transverse uterine incision. However, a repeat C-section is sometimes the safer delivery method depending on your medical history and pregnancy factors. Discuss the pros and cons with your healthcare provider early on to determine if trying for a vaginal birth after C-section is the right choice for you.
What is VBAC?
VBAC stands for vaginal birth after cesarean. It refers to giving birth through the vagina after a woman has had a previous delivery via cesarean section (C-section).
A C-section is a major abdominal surgery that involves making incisions in the abdomen and uterus to deliver a baby. Like all surgeries, it brings both benefits and risks.
For some women who have undergone a prior C-section, vaginal delivery may be possible for their next birth. This is called a VBAC or vaginal birth after cesarean.
What are the benefits of VBAC?
There are several potential benefits of having a vaginal delivery instead of a repeat C-section:
- Faster recovery – A vaginal birth involves less healing time compared to a major surgery like a C-section. Most women are able to get back to their usual activities much sooner after a VBAC.
- Shorter hospital stay – Women usually get to go home from the hospital sooner after a vaginal delivery versus surgical delivery.
- Lower infection risk – The incisions made during a C-section create more opportunity for infection compared to an uncomplicated vaginal birth.
- Avoid repeat surgeries – Multiple C-sections come with increased scar tissue, bleeding, risks, and complications in future pregnancies and deliveries.
- Greater chance of vaginal delivery in the future – Once a woman has a C-section, her chances for needing repeat cesareans for additional births goes up. A successful VBAC opens the door for more potential vaginal deliveries moving forward.
While VBAC comes with its own potential risks, for many women the benefits outweigh the risks compared to having a routine repeat C-section.
What are the risks of VBAC?
Though serious complications are rare, VBAC does come with some risks including:
- Uterine rupture – During a trial of labor for VBAC, the old C-section scar can separate and cause the uterus to tear open. This is called uterine rupture and it requires an emergency C-section to deliver the baby quickly.
- Uterine dehiscence – A less severe complication is uterine dehiscence, where the prior C-section scar thins out and begins to open but does not completely separate. Rest usually allows it to heal, but unplanned C-section may be needed.
- Unplanned C-section – Even with a trial of labor, there is no guarantee of delivering vaginally. Failed induction, stalled labor, fetal distress or other complications can lead to an unplanned C-section.
- Higher blood loss – Vaginal tearing along with issues like placental problems or uterine atony can sometimes cause heavier postpartum blood loss in VBACs versus planned repeat C-sections.
- Neonatal morbidity – Babies born after a failed trial of labor may have more health and breathing problems compared to a planned C-section.
Talking through both the potential benefits and risks helps women and their healthcare teams make the best decisions about attempting VBAC or scheduling a repeat C-section.
What factors make VBAC more likely to be successful?
Certain factors may increase a woman’s chance of successfully delivering vaginally after cesarean section. These include:
- Having a prior vaginal delivery – Women who have had a previous vaginal birth along with a C-section have the highest VBAC success rates.
- Favorable reason for prior C-section – If the previous C-section was for breech positioning or a non-recurring issue like fetal distress, VBAC is often more likely to succeed.
- Spontaneous labor – Going into labor naturally before your due date increases VBAC success compared to being induced.
- Supportive provider and delivery location – Choosing an OB and hospital equipped for VBAC and emergency cesarean if needed leads to better outcomes.
- Low vertical scar – A low, transverse (horizontal) uterine incision from the previous C-section makes rupture less likely than a vertical incision.
- Normal pregnancy – The absence of gestational diabetes, high blood pressure or other complications improves VBAC chances.
While there are no guarantees, the more factors that align in a woman’s favor, the more likely she is to deliver vaginally after cesarean section.
Can I attempt VBAC after multiple C-sections?
Most VBAC guidelines allow considering a trial of labor after one, and sometimes two prior low transverse cesarean sections. As the number of past C-sections rises, the chances of achieving a vaginal delivery falls while the risks increase.
However, VBAC may still be possible in select cases of multiple C-sections. According to ACOG guidelines, a trial of labor after two prior cesareans has around a 40-45% success rate. Success rates after more than two C-sections are difficult to predict given how uncommon VBAC is in those cases.
Talk to your doctor about whether VBAC may be a safe option after multiple cesarean deliveries given your unique surgical and obstetric history.
How to prepare for a VBAC
Women attempting a VBAC need to plan ahead and be ready in case plans change and a repeat C-section is needed after all. Here are some tips for preparing for a vaginal delivery after cesarean:
Find a supportive provider
Not all physicians and hospitals allow VBACs, so doing research beforehand is key. Look for an obstetrician and facility that are equipped to support VBACs and respond quickly with an emergency cesarean if necessary. Confirm your provider’s specific VBAC success rates if possible.
Get counseling on risks
Your doctor should discuss the potential risks and benefits of both repeat C-section and VBAC at length. Ensure you understand the options, ask questions if you have any doubts, and give informed consent to attempting VBAC.
Take a childbirth education class
Childbirth classes help women learn techniques for healthy labor and delivery. Classes tailored to VBAC give moms-to-be extra insight into the process including pain control options without epidurals.
Consider a doula
Doulas provide support throughout labor and delivery but are not medical professionals. Hiring one skilled in VBACs may help increase your chances of success and provide an extra layer of care.
Get in optimal health
Eat well, exercise, take prenatals, stop smoking, and correct anemia or gestational diabetes to get your body ready for the hard work of labor. Your provider may limit VBAC if certain health conditions develop.
Prepare for unplanned C-section
There are never guarantees, so mentally prepare for a repeat cesarean if VBAC plans change. Have your bag packed and talk to your doctor about recovery if another abdominal surgery is needed.
Gather support people
Line up your labor coach and any other trusted support people to be by your side during the trial of labor. Their encouragement can make a big difference.
Rest up near your due date
Conserve your energy with plenty of rest late in pregnancy. You’ll need your strength for active labor, whether you deliver vaginally or by cesarean.
VBAC Labor Tips
If you will attempt a vaginal birth after C-section (VBAC), these tips may help promote progress during your trial of labor:
Have labor induced
Discuss inducing labor with your doctor instead of waiting for spontaneous labor if the pregnancy continues past 40 weeks. Induction decreases VBAC risks like uterine rupture.
Use intermittent monitoring
Allow fetal monitoring periodically versus continuous EFM, which limits positioning and mobility.
Avoid an early epidural
Delaying epidural placement as labor progresses allows your body to release oxytocin to strengthen contractions.
Change positions frequently
Shift positions often to aid progress and use positions like squatting that utilize gravity.
Stay hydrated
Drink fluids regularly so dehydration doesn’t stall your contractions.
Listen to your body
Pay attention to symptoms of uterine rupture like sudden abdominal pain or unusual bleeding.
Use pain relief alternatives
Consider a birth ball, warm shower, massage, breathing techniques, hypnobirthing and other non-drug options for pain.
Have a support person encourage you
A doula or loved one cheering you on can give motivation to keep laboring.
Change activity level
Alternate between walking, resting, sitting upright, and lying on your side to find what works.
Stay calm
Anxiety and tension can stall progress, so use relaxation techniques and your support team to stay focused.
What happens if VBAC fails?
While many trials of labor after cesarean section (VBACs) are successful, vaginal delivery is never guaranteed. VBACs sometimes fail to progress and result in unplanned C-sections for maternal or fetal indications. If your VBAC does not go as planned, here is what you can expect:
Emergency C-section
The most urgent reason for a failed VBAC is uterine rupture, which requires emergency surgery to deliver the baby rapidly. However, more commonly stalled labor or fetal distress will necessitate an unplanned C-section non-urgently.
Surgical risks
Unplanned repeat surgery carries more risks of bleeding, infection, and complications from anesthesia than a planned C-section would have. You will also have a horizontal skin incision on top of your old vertical scar.
Recovery
Recovering from surgery after laboring tends to be harder than recovering from an elective repeat C-section. But with rest, pain management and help at home most women bounce back within 4-6 weeks.
Emotional impact
Failed VBACs can be emotionally difficult after preparing for a vaginal delivery. Postpartum depression screening is important, and counseling helps many women process the experience.
Future deliveries
Most providers recommend repeat scheduled C-sections after one failed VBAC trial. However, VBAC may still be possible in the future in certain circumstances after discussion with your doctor.
Healthy mom and baby
While disappointing, an unplanned C-section for VBAC failure still results in a healthy mother and newborn in the vast majority of cases, which is the ultimate goal.
Conclusion
Vaginal birth after cesarean section is a reasonable choice and safe option for most women with a prior low transverse uterine incision. However, VBAC does carry risks that women must carefully weigh against potential benefits with their healthcare providers. Not every woman is an ideal VBAC candidate, and failed trial of labor occurs in 25-40% of cases, but 60-75% are successful if women are well-selected. With appropriate counseling and preparation, many women can avoid repeat major surgery and recover faster through VBAC. However, scheduled repeat C-section is still the safest choice for some women based on their unique medical history and risks.