Can I Have a Vaginal After Birth C-Section (VBAC)? The Facts, Risks, and Safety

Can you have a vaginal birth after C-section? Many parents who have previously delivered a baby via cesarean hope to avoid the procedure with the next baby. The good news is that, in many cases, vaginal birth after cesarean (VBAC) is a viable option. In 2013, the success rate for American women who attempted a trial of labor after one previous cesarean (TOLAC) was 70%. While the overall risk of complications is small, a VBAC delivery does carry higher risks than vaginal birth. It’s essential to learn the facts and discuss your concerns and preferences with your healthcare provider ahead of time.

What Are the Advantages of a VBAC?

There are a number of reasons a person may want to attempt a vaginal birth after a C-section. Some people just want to experience a vaginal birth, and a successful VBAC allows them to do that. There are a number of medical benefits as well:

• Reduced loss of blood
• Elimination of the need for abdominal surgery and all its associated risks and complications
• Reduced risk of infection
• Faster recovery time
• Helps clear the baby’s lungs as they pass through the birth canal, better preparing the baby to breathe oxygen after birth

For people who want to have additional children in the future, a VBAC may help them bypass some of the health issues linked to multiple cesarean deliveries, including hysterectomy, bladder or bowel injury, and placenta problems.

What Risks Are Associated with a VBAC?

While a successful VBAC is linked to fewer complications than an elective repeat C-section, a failed trial of labor after a C-section is linked to increased complications, including uterine rupture. Uterine ruption is a dangerous tearing of the uterine muscle or past C-section scar. Although a rupture of the uterus is quite rare, it is extremely serious and may harm both you and your fetus. An emergency cesarean delivery is needed to prevent life-threatening complications. Treatment might also include surgical removal of the uterus (hysterectomy). Other risks from uterine rupture include blood clots, blood loss, infection, and bladder damage. 

Because of this, the American College of Obstetricians and Gynecologists says that VBAC should take place in a hospital that can manage situations that threaten the life of the pregnant parent and their baby. VBAC may not be available at some hospitals because their staff does not feel they can provide this type of emergency care. Consider the resources available at the hospital you have selected. The American College of Obstetricians and Gynecologists recommends that people with a high risk of uterine rupture not attempt a VBAC delivery.

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Does the Type of Incision Used in a Previous C-Section Matter?

It might. A C-section delivery will leave a scar on both your skin and your uterus. Some uterine scars are more prone to rupture during VBAC. The type of scar depends on the type of cut in the uterus:

• Low transverse: A side-to-side cut made across the lower, thinner part of the uterus. This is the most common type of cut and has the lowest chance of future rupture.
• Low vertical: An up-and-down cut made in the lower, thinner part of the uterus. This type of cut has an increased risk of rupture than a low transverse incision.
• High vertical (also called “classical”): An up-and-down incision made in the upper part of the uterus, sometimes done for very preterm cesarean deliveries. It carries the most significant risk of rupture.

It’s important to note that the type of incision made in the uterus cannot be determined simply by looking at the scar on the skin's surface. Obtain copies of your medical records from the previous delivery so that your healthcare provider can review them and make an informed recommendation. 

Is VBAC Right For Me?

Your healthcare provider will evaluate a number of considerations in order to determine whether you may or may not be a good candidate for a successful VBAC. In general, VBACs are safest for individuals who:

• have had a vaginal delivery at least once before or after a prior C-section
• have had fewer than two prior C-sections
• have not had other uterine surgeries (e.g., fibroid removal)
• had a low transverse or low vertical incision with a previous C-section
• have never experienced a uterine rupture
• do not need induction to start labor
• will be delivering more than 18 months after a previous delivery
• do not have other health concerns that may affect a vaginal delivery (e.g., placental problems, the baby being in an abnormal position, or a pregnancy involving triplets or higher order multiples)
• plan to deliver at a facility equipped to handle an emergency C-section

How Can I Prepare for a VBAC?

If you want to attempt a vaginal birth after C-section and think you may be a good candidate, start exploring your option during the early months of your pregnancy. If your hospital or physician doesn’t permit VBACs, look into using a different provider. For instance, it’s more likely that a large hospital with a Level-3 neonatal intensive care unit and 24-hour anesthesiologists on standby will allow a VBAC than a small community medical center.

You should also read as much as possible about the process and enroll in a childbirth class that discusses VBAC delivery. Look for information and support from midwives, childbirth educators, doulas, and online from other women who’ve experienced vaginal birth after C-section. Though research supports the safety of many VBAC procedures, it’s still not considered a mainstream choice in many places so a good support network is essential. Ultimately, it’s important to remember that regardless of how your baby comes into this world, the focus should be on keeping mother and baby as healthy and safe as possible.