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

Many women are candidates for vaginal birth after cesarean (VBAC). Still, the choice to pursue VBAC or schedule a repeat C-section can be difficult. Here's insight on how to make the decision.

Why would a woman consider VBAC?

Compared with having another C-section, a vaginal delivery involves no surgery, a shorter hospital stay and a quicker return to normal daily activities. VBAC might also be appealing if you have an emotional investment in a vaginal delivery or a desire to experience vaginal childbirth.

It's important to consider future pregnancies, too. If you're planning more pregnancies in the future, VBAC might help you avoid the risks of multiple cesarean deliveries, such as bowel or bladder injury and placenta problems.

What are the risks of VBAC?

The most obvious possible risk is failed labor. 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.

The most concerning risk of VBAC is uterine rupture — when the uterus tears open along the scar line from a prior C-section or major uterine surgery. 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.

Other risks of a failed TOLAC include surgical wounds, bleeding complications that require a hysterectomy or transfusion, and infection.

Can you put the risk of uterine rupture into perspective?

Uterine rupture is rare, occurring in less than 1 out of 100 women. If you're considering VBAC, 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.

Who's eligible for VBAC?

VBAC eligibility depends on many factors. For example:

  • Have you had previous vaginal deliveries? A vaginal delivery at least once before or after your prior C-section increases the probability of a successful VBAC.
  • What type of uterine incision was used for the prior C-section? Most C-sections use a low transverse incision. Women who have had a low transverse incision are usually VBAC candidates. If you've had a vertical incision in the upper part of your uterus (classical incision), VBAC is not recommended due to the risk of uterine rupture.
  • What prompted the prior C-section? If your prior C-section was done for a reason that isn't present during your current pregnancy — such as the baby's position in your uterus — you might be a good candidate for VBAC.
  • How many C-sections have you had? You might be a less suitable candidate for VBAC if you've had multiple C-sections.
  • When was your last C-section? The risk of uterine rupture is higher if you attempt VBAC too soon after having a C-section — such as within 18 to 24 months.
  • Do you have any health concerns that might affect a vaginal delivery? A C-section might be recommended if you have placenta problems, a breech presentation or an infection that could be passed to your baby during vaginal delivery — such as genital herpes or HIV.
  • Where will you deliver the baby? Plan to deliver at a facility equipped to handle an emergency C-section. A home delivery isn't appropriate for VBAC.
  • Will you need to be induced? Likewise, VBAC should be approached with caution if medication is needed to induce labor.

Also, keep in mind that if you had a uterine rupture during a previous pregnancy, you're not a candidate for VBAC.

How does labor and delivery during VBAC differ from labor and delivery during a routine vaginal birth?

The actual physiology of labor and delivery is the same. However, you and your baby will be closely monitored. Your health care provider will be prepared to do a repeat C-section if needed.

What other advice do you offer women who are considering VBAC?

If you're considering VBAC, discuss the option with your health care provider early in pregnancy.

Find out about the VBAC policy at the facility where you'll deliver your baby, but try to stay flexible. The circumstances of your labor could make VBAC a clear choice — or, after counseling, you and your health care provider might decide that a repeat C-section would be best after all.

July 02, 2015 See more In-depth