Vaginal birth after cesarean, or VBAC, refers to vaginal delivery of a baby after a previous pregnancy was delivered by cesarean delivery. Having a VBAC is a viable option for many women, but there are a number of considerations you’ll want to take into account and discuss with your healthcare provider before you decide whether or not you want to pursue one.

The safety of both mother and child is the number one priority when evaluating the pros and cons of vaginal birth after cesarean delivery. The procedure puts some people at a high risk of serious, possibly life-threatening complications. For others, VBAC offers the safest option with the fewest risks. Let's take a closer look at the pros and cons of vaginal birth after cesarean section and whether it may be right for you.

The Pros of VBAC

1. There’s no surgery involved.

A vaginal birth eliminates the need for surgery and all the possible complications that follow. You won’t have to stay in the hospital as long, and you’ll be able to return to your normal everyday activities more quickly. For many people, this is one of the most attractive benefits when considering VBAC as an option.

2. There are fewer risks associated with VBAC.

According to the American Pregnancy Association, published studies reveal that 60% to 80% of people who had a cesarean birth have had a successful vaginal birth in their next pregnancy. This statistic is reinforced by another from the National Institute of Child Health and Human Development that shows (among appropriate candidates) that about 75% of VBAC attempts are successful.

3. There’s less chance of infection with VBAC.

Research published by the National Institute of Health compared infection rates among women who had a C-section with women who had a vaginal birth. Within 30 days postpartum, 7.6% of women who had undergone C-sections acquired an infection compared to only 1.6% of women who had a vaginal birth. Their conclusion? The risk of postpartum infection seems to be nearly five-fold increased after a C-section compared with vaginal birth. In addition to minimizing this risk, VBAC offers fewer issues with blood loss, deep vein thrombosis, and fewer complications related to the administration of anesthesia (if used at all).

4. VBAC is usually better for babies.

A successful VBAC also poses a number of advantages for newborns. Vaginal birth helps clear your baby’s lungs as they are squeezed through the birth canal. This better prepares your baby to breathe oxygen after birth and reduces the chance they will experience breathing problems. Babies also have a lower chance of experiencing immune system-related issues like asthma or allergies due to the boost of good bacteria they pick up during their journey through the birth canal.

5. Breastfeeding might be easier.

Research from the National Institute of Health shows a higher success rate for breastfeeding following VBAC. Women delivered by successful VBAC were 47% more likely to initiate breastfeeding than women who delivered by scheduled repeat cesarean. Pain medications that sedate the mother for a C-section may even affect the baby’s ability to latch on and nurse. In addition, the routine procedures following a cesarean birth, like suctioning the newborn’s mouth, esophagus, and airways can also make it more difficult for babies to begin and continue breastfeeding.

6. VBAC can help minimize the risk for subsequent pregnancies.

People who have multiple repeat cesarean deliveries are at increased risk of problems with the placenta, complications related to adhesions, and incision-related complications. If you're planning for more pregnancies in the future, VBAC might help you minimize the possible risks that can occur when multiple cesarean deliveries happen. 

7. There’s less need for stomach support during recovery.

A C-section is major surgery with restrictions on what you’re able to do during recovery. You’ll be limited on what you can lift during the first month or two after birth (nothing heavier than the baby). You’ll also need to support your stomach in the weeks afterward every time you laugh, sneeze, or cough to avoid ripping your stitches. With a VBAC, this need is eliminated.

The Cons of VBAC

1. Not all women are candidates for VBAC.

There are a number of factors that may affect whether or not you’re even a good candidate for VBAC. According to the Mayo Clinic, you may not qualify for VBAC if you’ve experienced any of the following:

• a prior high vertical (classical) incision.
• a previous uterine rupture.
• other surgeries on your uterus, such as fibroid removal
• two or more prior C-sections
• another birth less than 18 months ago
• other health concerns that may affect vaginal delivery (e.g., the baby is in an abnormal position or you’re carrying multiple babies)
• you require labor induction

2. Labor may cause scars to tear.

Though the risk is very low, it’s a significant one. The rate of uterine rupture with one prior low-transverse scar has been reported by the American College of Obstetricians and Gynecologists to be between 0.2 and 1.5 percent (one of 67 to 500 women). Other studies involving more than 130,000 women undergoing a trial of labor for VBAC report rates that average 0.6 percent (approximately one of every 170 women). In women with two or more prior cesareans, the rate of rupture rises as high as 3.9 percent (one of 26 women).

3. Home delivery is not an option with VBAC.

Once you’ve undergone a C-section, you are no longer eligible (from a medical perspective) to have a home birthing plan. With VBAC, your healthcare provider will want you to labor at a facility that is equipped to perform an emergency C-section. This way, you will have a backup option that can save your life and your baby’s life if problems arise. 

4. Labor can be traumatizing for some people.

Fear of the unknown may lead some people to choose an elective C-section. The uncertainty of what to expect and fear of contractions and pushing is overwhelming for some, making a repeat surgical procedure seem less frightening. Still, others fear facing hours of strenuous labor, only to end up in surgery anyway because of a complication from the VBAC.

What to Discuss With Your HealthCare Provider

VBAC carries a number of potential risks and benefits. Talk to your doctor about the pros and cons and how they could affect your pregnancy. Specific topics you’ll want to address include the following:

• Any prior pregnancies and births
• Reason why you had a C-section
• Possible consequences and safety of a repeat C-section for you and for your infant
• Reasons why you should or shouldn’t consider VBAC
• Whether labor will need to be induced
• Whether the childbirth facility is equipped to handle any possible emergency delivery complications
• Your plans for future pregnancies

The Bottom Line on Whether VBAC Is Safe

Start having conversations about the pros and cons of a VBAC as early as you can with your healthcare provider. Their goal is to help you have the birthing experience you want while making it as safe as possible for you and your baby. No matter what, try to stay flexible. The circumstances of your pregnancy could make VBAC an easy choice or, after some discussion, you and your doctor might decide that another C-section would be best after all.