VBAC: Insight from a Mayo Clinic specialist

Wonder if you're a good candidate for VBAC? If the benefits of VBAC outweigh the risks? The answer might be up to you. Here's help weighing the pros and cons. By Mayo Clinic Staff

Years ago, a C-section ended any hope of future vaginal deliveries. Today, however, many women are candidates for vaginal birth after cesarean (VBAC). Still, the choice to pursue VBAC or schedule a repeat C-section can be tough.

Here's insight from Roger W. Harms, M.D., an obstetrician at Mayo Clinic, Rochester, Minn., and medical editor-in-chief of MayoClinic.com.

Why would a woman consider VBAC?

The risks associated with a vaginal delivery are lower than the risks associated with a C-section overall — as long as you can deliver the baby at a facility equipped to handle a C-section in case of emergency — and the recovery time is faster. VBAC might also be appealing if you have an emotional investment in a vaginal delivery or a desire to experience natural childbirth.

It's also important to consider future pregnancies. If you've had one C-section and you're certain this is your last delivery, the difference in risk between VBAC and a second C-section is probably minimal. However, if you're planning more pregnancies in the future, VBAC becomes a better option with each subsequent delivery.

What are the risks of VBAC?

For about 25 percent of women who attempt VBAC, labor ends in a repeat C-section. This is known as a failed trial of labor after cesarean.

If you must have a repeat C-section after labor has begun, you face a slightly higher risk of C-section complications, such as a uterine infection. The most concerning risk of VBAC, however, is uterine rupture — when the baby breaks through the wall of the uterus into the mother's abdominal cavity.

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.

Can you put the risk of uterine rupture into perspective?

Uterine rupture is rare, affecting fewer than 1 out of 100 women who've had a prior low transverse uterine incision — the most common type for a C-section. Still, it's possible. And naturally, the risk of uterine rupture causes concern.

If you're considering VBAC, what's important is to make sure that the facility where you'll deliver the baby is ready to deal with that complication. You'll need staff immediately available to provide emergency care.

Nov. 06, 2012 See more In-depth