If you’ve had a cesarean birth (C-section), you may wonder if you can have a vaginal birth with your next pregnancy. For many people, it’s possible to have a VBAC, or vaginal birth after cesarean.
About 60 to 80 percent of women who try to have a vaginal birth after a previous C-section have a successful VBAC. Doctors use the clinical term trial of labor after cesarean (TOLAC) to describe the attempt to have a vaginal birth while VBAC describes the successful outcome. Your individual chances of having a VBAC depend on factors such as your previous birth history, the type of incision used during your C-section and your current pregnancy.
Understanding the benefits and risks of a vaginal birth after a C-section can help you and your doctor decide what’s best for you and your baby.
What Are the Benefits of VBAC?
A successful VBAC may offer several benefits compared with a repeat C-section, including:
- Avoiding abdominal surgery
- Shorter recovery
- Lower risk of infection
- Less blood loss
- Avoiding another uterine scar
Avoiding another C-section may also reduce some risks associated with multiple cesarean deliveries in future pregnancies, including certain placenta-related complications.
Is a VBAC Safe?
For many people, a VBAC can be a safe option. However, labor after a previous C-section has risks that differ from those of a planned repeat C-section.
The most serious concern is uterine rupture, which occurs when the scar on the uterus from a previous C-section opens during labor. It’s rare but can be a serious emergency for both mother and baby. If uterine rupture or another complication occurs, an emergency C-section may be needed. Other risks include infection and blood loss.
Who May Be a Candidate for VBAC?
There is no single checklist that determines whether someone can have a VBAC. Your OB/GYN provider will consider your medical history, previous C-section and current pregnancy.
Factors that may be considered include:
- Type of uterine incision: A low transverse, or side-to-side, incision is the most common and has the lowest risk of uterine rupture among the commonly used incision types.
- Number of previous C-sections: Having more than one previous C-section does not automatically rule out VBAC, but your medical history will need to be carefully reviewed.
- Previous vaginal birth: A previous vaginal birth, particularly a VBAC, may increase the likelihood of success.
- Reason for your previous C-section: Why your first C-section was needed can help your doctor assess your chances.
- Current pregnancy: Your health, your baby’s position and other pregnancy complications may affect whether a vaginal birth is recommended.
Your provider may also review your previous C-section records. The incision on your skin does not necessarily show what type of incision was made on your uterus. Your medical records can provide this information.
What Happens During VBAC Labor?
Labor after a previous C-section is similar to other labor, but you and your baby may receive closer monitoring.
Your care team will monitor your baby’s heart rate and your contractions and watch how labor progresses. If a concern develops, they may recommend an emergency C-section. VBAC is generally planned in a hospital that can provide emergency care if needed. Being monitored closely does not mean something will go wrong. It allows your care team to respond quickly if a concern develops.
Can I Be Induced During a VBAC?
If labor does not begin on its own, you may wonder whether you can still try for a VBAC. Labor induction may be possible after a previous C-section, but some methods of induction carry more risk than others. Induction can also lower the chance of a successful VBAC and may increase the risk of complications during labor. Your provider will consider your individual circumstances when deciding whether induction is appropriate and which methods can be used.
When Is a Repeat C-Section Recommended?
Sometimes a planned repeat C-section is the safer choice. Your provider may recommend against labor if the risks are too high.
A repeat C-section may be recommended because of:
- A previous uterine incision associated with a higher risk of rupture, such as a high vertical or classical incision
- Certain placenta-related complications
- A health condition that makes vaginal birth unsafe
- Certain fetal positions or other circumstances that make vaginal birth unsafe
- Other factors related to your medical history or current pregnancy
Having a repeat C-section does not mean you made the wrong choice. The goal is to choose the safest way to deliver your baby based on your individual circumstances.
Questions to Ask Your Provider About VBAC
If you’re considering a VBAC, ask your provider:
- Am I a candidate for VBAC?
- What type of uterine incision did I have?
- What is my chance of a successful VBAC?
- How does the reason for my previous C-section affect my chances?
- Can I be induced if I don’t go into labor on my own?
- Does this hospital offer VBAC and emergency C-section care?
- What would happen if my labor does not progress?
Frequently Asked Questions
Can I have a VBAC after two C-sections?
In some cases, yes. Having two previous C-sections does not automatically rule out a vaginal birth. Your previous surgeries, uterine incisions and current pregnancy all factor into the decision.
Can I have a VBAC if my first C-section was for a breech baby?
Yes, a previous C-section for a breech baby does not automatically prevent you from having a VBAC. The reason for your previous C-section can affect your chances of a successful vaginal birth. A C-section performed because of a baby’s position may have different implications than one performed because labor did not progress.
How long after a C-section can I have a VBAC?
There is no single waiting period that determines whether you can have a VBAC. However, a shorter interval between pregnancies may increase certain risks during labor. The amount of time since your previous C-section is one factor your provider will consider when discussing your delivery options.
What happens if my VBAC is not successful?
If labor does not progress or you or your baby develop a problem, you may need an unplanned C-section. Your care team will monitor you and your baby during labor and recommend a C-section if it becomes the safest option.
Deciding if a VBAC Is Right for You
Having a previous C-section does not necessarily mean you need another C-section. For some people, planning for a VBAC can lead to a successful vaginal birth and allow them to avoid another surgery.
Talk with your obstetrician or midwife early in pregnancy about your birth options. Together, you can review your medical history, discuss the benefits and risks and make a plan that prioritizes the health and safety of you and your baby.
The Midwifery Practice at Stony Brook Medicine provides comprehensive, patient-centered care for women throughout every stage of life, from adolescence through menopause. Established in 1996, the practice is staffed by certified nurse-midwives and certified midwives who are faculty members within the Department of Obstetrics, Gynecology and Reproductive Medicine at Stony Brook Medicine’s Renaissance School of Medicine. The team offers a full spectrum of women’s health services, including preventive care, pregnancy and childbirth support, gynecologic care and menopause management. Guided by a philosophy that prioritizes the needs, preferences and well-being of each patient, The Midwifery Practice combines evidence-based care, education and collaboration to support women and families across Long Island. Learn more or call (631) 444-4686 to make an appointment.
