If you've delivered a baby by C-section and you're pregnant again, you might be able to choose between scheduling a repeat C-section or attempting vaginal birth after C-section (VBAC).

For many women, VBAC is an option. In fact, research on women who attempt a trial of labor after cesarean (TOLAC) shows that about 60 to 80 percent have a successful vaginal delivery.

VBAC isn't right for everyone, though. Certain factors, such as a high-risk uterine scar, can make VBAC inappropriate. Some hospitals don't offer VBAC because they don't have the staff or resources to handle emergency C-sections. If you're considering VBAC, your health care provider can help you understand if you're a candidate and what's involved.

Women consider VBAC for various reasons, including:

  • Shorter recovery time. You'll have a shorter hospital stay after a VBAC than you would after a repeat C-section. Avoiding surgery will help your energy and stamina return more quickly, as well as reduce the expense of childbirth.
  • More participation in the birth. For some women, it's important to experience a vaginal delivery. Your labor coach and others also may be able to play a greater role.
  • Impact on future pregnancies. If you're planning a larger family, VBAC might help you avoid the risks of multiple cesarean deliveries.

The chances of a successful VBAC are higher if:

  • You've had only one prior low transverse uterine incision — the most common type for a C-section
  • You and your baby are healthy and your pregnancy is progressing normally
  • The reason you had your prior C-section isn't a factor this time
  • Your labor begins naturally on or before your due date
  • You've had a previous successful vaginal delivery

The chances of a successful VBAC are lower if:

  • Your pregnancy continues beyond your due date
  • You have an unusually large baby — suspected fetal macrosomia
  • You've had two or more C-sections

You're not a candidate for VBAC if you had a uterine rupture during a previous pregnancy. Similarly, VBAC isn't recommended if you have had a vertical incision in the upper part of your uterus (classical incision) due to the risk of uterine rupture.

VBAC poses potentially serious risks, including:

  • Failed attempt at labor. Labor can results in a repeat C-section.
  • Uterine rupture. Rarely, the uterus might tear open along the scar line from a prior C-section. If your uterus ruptures, an emergency C-section is needed to prevent life-threatening complications, including heavy bleeding and infection for the mother and brain damage for the baby. In some cases, the uterus might need to be removed (hysterectomy) to stop the bleeding. If your uterus is removed, you won't be able to get pregnant again.

If you choose VBAC, boost your odds of a positive experience:

  • Learn about VBAC. Take a childbirth class on VBAC. Include your partner or another loved one, if possible. Also discuss your concerns and expectations with your health care provider. Make sure he or she has your complete medical history, including records of your previous C-section and any other uterine procedures.
  • Plan to deliver the baby at a well-equipped hospital. Close monitoring can decrease the risk of complications. Look for a facility that's equipped to handle an emergency C-section.
  • Allow labor to begin naturally, if you can. Drugs to induce labor can make contractions stronger and more frequent, which might contribute to the risk of uterine rupture — especially if the cervix is tightly closed and not ready for labor.
  • Be prepared for a C-section. Some complications of pregnancy or delivery might require a C-section. For example, you might need a C-section if there's a problem with the placenta or umbilical cord, your baby is in an abnormal position or your labor fails to progress.

If you choose VBAC, your prenatal care will be just like the care you'd receive during any other healthy pregnancy.

When you go into labor, you'll follow the same process as any woman expecting to deliver vaginally — although you and your baby will be more closely monitored during labor. Your health care provider will be prepared to do a repeat C-section if needed.

June 12, 2015