Overview

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 a vaginal birth after cesarean (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 lower your likelihood of VBAC and make the option 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.

Why it's done

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 you resume your normal activities sooner, as well as reduce the expense of childbirth.
  • Opportunity for an individualized birth plan. For some women, it's important to experience a vaginal delivery.
  • Impact on future pregnancies. If you're planning to have a larger family, VBAC might help you avoid the risks of multiple cesarean deliveries, such as scarring. Scarring might make additional surgery difficult and increase the risk of placental problems in pregnancies.
  • Lower risk of surgical complications. Vaginal deliveries have lower rates of bleeding, infection, blood clotting in one or more of the deep veins in the body (deep vein thrombosis), and injury to abdominal organs, such as the bladder or bowel.

You might be a candidate for VBAC if you are:

  • Pregnant with one baby, have a history of one or two prior low transverse C-sections, and have no problems that would prevent VBAC
  • Pregnant with one baby, have a history of one prior C-section with an unknown type of uterine incision, and have no problems that would prevent VBAC — unless it's suspected that you had a prior high vertical (classical) uterine incision
  • Pregnant with twins, have a history of one prior low transverse C-section, and are otherwise a candidate for a twin vaginal delivery

You're not a candidate for VBAC if you have had:

  • A prior high vertical (classical) uterine incision
  • An unknown type of prior uterine incision and it's suspected that it was a high vertical (classical) incision
  • A prior uterine rupture
  • Certain types of prior uterine surgery, such as fibroid removal

Some health care providers won't offer VBAC if you've had more than two prior C-sections. VBAC also generally isn't an option if you are pregnant with triplets or higher order multiples.

Factors that decrease the likelihood of VBAC include:

  • Stalled labor
  • Advanced maternal age
  • Pregnancy that continues past 40 weeks
  • Body mass index greater than or equal to 40 (severe maternal obesity)
  • Excessive weight gain during pregnancy
  • Preeclampsia
  • Previous delivery within 18 months
  • History of two or more prior C-sections and no vaginal deliveries
  • A need labor induction

Risks

While VBAC is associated with fewer complications than an elective repeat C-section, a failed trial of labor after cesarean (failed TOLAC) is associated with more complications, including, rarely, a uterine rupture. If your uterus tears open during labor, an emergency C-section is needed to prevent life-threatening complications, such as heavy bleeding for the mother. If the rupture is complex or to stop the bleeding, the uterus might need to be removed (hysterectomy). If your uterus is removed, you won't be able to get pregnant again.

How you prepare

If you've previously had a C-section and you're pregnant, you might begin talking about VBAC at your first prenatal visit. 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. Your health care provider might use your medical history to calculate the likelihood that you'll have a successful VBAC. It's important to continue discussing the risks and benefits of VBAC throughout pregnancy, especially if certain risk factors arise.

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

  • Learn about VBAC. Take a childbirth class on VBAC.
  • Plan to deliver the baby at a well-equipped hospital. Look for a facility that's equipped to handle an emergency C-section.
  • Allow labor to begin naturally, if you can. Having labor induced or augmented decreases the likelihood of VBAC.
  • Be flexible. Some complications of pregnancy or labor 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.

What you can expect

If you choose VBAC, when you go into labor you'll follow the same process that's used for any vaginal delivery. Your health care provider will likely recommend continuous monitoring of your baby's heart rate and be prepared to do a repeat C-section if needed.

July 06, 2018
References
  1. Metz TD, et al. Choosing the route of delivery after cesarean birth. https://www.uptodate.com/contents/search. Accessed May 22, 2018.
  2. American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins — Obstetrics. ACOG Practice Bulletin No. 184: Vaginal birth after cesarean delivery. Obstetrics & Gynecology. 2017;130:e217.
  3. AskMayoExpert. Vaginal birth after cesarean (VBAC). Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2018.
  4. Frequently asked questions. Labor, delivery and postpartum care FAQ070. Vaginal birth after cesarean delivery. American College of Obstetricians and Gynecologists. https://www.acog.org/Patients/FAQs/Vaginal-Birth-After-Cesarean-Delivery. Accessed May 29, 2018.

Vaginal birth after cesarean (VBAC)