Vaginal Birth After Cesarean: Are You a Candidate?

If you had a cesarean delivery with a prior pregnancy, you may be wondering what that means for your future pregnancies. For a long time, women were told “once a c-section, always a c-section.” While for some women that remains true, many women now have two options: scheduling a c-section or attempting vaginal birth after cesarean (VBAC).

Why might I consider a VBAC?

In addition to the fact that you may simply wish to experience a vaginal birth, VBAC can also help you avoid a c-section and the risks associated with this major abdominal surgery. Compared to a c-section, a vaginal birth has a shorter recovery time, a shorter hospital stay, a lower risk of infection, and less blood loss. Sixty to eighty percent of women who attempt a trial of labor after cesarean (TOLAC) go on to have a successful vaginal birth.

Why might I not consider a VBAC?

A VBAC is not without risk – namely, the risk of uterine rupture. Uterine rupture is very rare, occurring in less than one percent of women who attempt a VBAC, but very serious for both you and your baby. Uterine rupture occurs when the uterine scar from your prior c-section tears open.

Who’s a good candidate for a VBAC?

Not all women are good candidates for a VBAC. The following factors are important to weigh when considering a VBAC:

  • Type of incision in your prior c-section: A low transverse (side to side) uterine incision is the most common incision used and has the lowest chance of rupture. A high vertical (up and down) uterine incision has the highest chance of rupture and precludes you from attempting a VBAC.
  • Number of prior vaginal deliveries and number of prior c-sections: A previous vaginal delivery increases your risk for a successful VBAC. On the other hand, two or more c-sections lower your chance of a successful VBAC.
  • Your health and your baby’s health: If you’ve had a healthy, problem-free pregnancy then you may be a good candidate for a VBAC. Certain problems in pregnancy or medical conditions could make a VBAC risky. Also, consider the reason you had a c-section in your prior pregnancy. If that reason is not a factor in this pregnancy, you’ll have a higher likelihood of a successful VBAC. A prior uterine rupture prohibits you from a VBAC.
  • The number of children you wish to have: If you’re planning on having more children, there can be complications associated with multiple c-sections.
  • When you go into labor: You will have a higher chance of a successful VBAC if you go into labor naturally on or before your due date.

 A VBAC is not for everyone and it is not without risk; it’s important that you do your own research and speak with your health care provider to determine the option that is right for you and your baby. Also, keep in mind that your plan may need to change. If you decide to attempt a VBAC, your plan may need to change to keep you and your baby safe. Likewise, if you decide to schedule a c-section but go into labor beforehand, a VBAC may be recommended.

Here, Dr. Allison Gray talks about VBAC and what makes one a great candidate.