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Vaginal Birth after Cesarean (VBAC) Delivery

Reviewed by James Brann, M.D.

Vaginal Birth after Cesarean (VBAC) Delivery: What Every Mother Should Know

Learn about a vaginal birth after having a cesarean birth.

Women who have had a Cesarean delivery (C-section) in the past may wish to try a spontaneous vaginal birth. This is called a vaginal birth after Cesarean (VBAC) delivery.

In the past, women who had a Cesarean delivery were told not to attempt a vaginal birth for any later children. Studies have shown, however, that most women can safely try to have a vaginal birth if they have had a prior Cesarean delivery.

Who Should Not Try a VBAC Delivery?

A VBAC delivery may be dangerous for some women. Your doctor or midwife may recommend against a VBAC delivery under the following circumstances:

  • You have had more than one Cesarean delivery in the past.

  • Your uterine incision from a prior Cesarean delivery was vertical or T-shaped.

  • You or the baby have a health condition that makes vaginal birth dangerous.

  • You tried a VBAC delivery before and were unsuccessful (for instance, your uterus ruptured).

  • You do not plan to have access to emergency Cesarean delivery help if the trial of labor fails.

  • You are pregnant with multiples or the baby presents in a risky position when you go into labor.

What are the Risks of a VBAC Delivery?

Although most women can have a safe and successful VBAC delivery, problems may arise that make a repeat Cesarean delivery essential. If you decide to make a trial of labor after a Cesarean delivery (TOLAC), you should be aware of the risks you face. Some women experience the following problems with an attempted VBAC delivery:

  • During spontaneous labor, the uterus tears opens again at the place of the incision from the past Cesarean delivery. This makes an emergency repeat Cesarean delivery essential.

  • The labor is longer or more difficult than expected. In these cases, a repeat Cesarean delivery may be necessary for the health of the mother or baby.

  • It may be difficult to find a doctor or midwife who is willing to support the decision to try natural labor.

What are the Benefits of a VBAC Delivery?

A VBAC delivery can be intimidating, but there are many potential benefits to them. For instance, some women are disappointed with the childbirth experience when they deliver by Cesarean, and a VBAC delivery enables them to experience traditional labor and childbirth. Some of the other benefits of VBAC deliveries include:

  • Lower risks of postpartum infection, blood clots, and other complications that can arise from a major surgery (like Cesarean delivery)

  • Shorter hospital stay and recovery time for most women

  • Increased likelihood of being able to deliver future children through vaginal birth

  • The baby may have fewer breathing troubles at birth

  • Vaginal birth may make breastfeeding easier for the mother and the baby

What are the Alternatives to VBAC Delivery?

If you have had a Cesarean delivery in the past, you may not feel comfortable trying to have a VBAC delivery. If you choose not to attempt natural, spontaneous labor, you can opt for a planned or elective Cesarean delivery.

Planned Cesarean deliveries are less likely than emergency Cesarean deliveries to have complications for the mother or the baby. Women who do not plan to have another Cesarean but are unable to complete a VBAC delivery may need an emergency Cesarean delivery. Elective repeat Cesarean deliveries are common and are very safe. However, they still carry the risks and downsides of a major surgery.

How Successful are Attempts at VBAC Delivery?

Some women who attempt to give birth vaginally after having had a Cesarean delivery are unable to do so. As many as 20-40% of women with a prior Cesarean delivery are unsuccessful when they try to have a VBAC delivery. Problems with the old uterine incision, the health of the mother or baby, or the position of the baby can make a vaginal birth dangerous or impossible. Although this “failure” rate may seem high, it still means that up to 8 in 10 women are able to have a safe, successful vaginal delivery even after a past Cesarean delivery.

What Can You Do to Have a Successful VBAC Delivery?

If you attempt natural labor after a Cesarean delivery, your healthcare provider should work with you to prepare for the experience. You may be able to increase your chances of having a successful VBAC by taking care of your health problems (like diabetes or high blood pressure), staying healthy during pregnancy, communicating your wishes to your doctor or midwife, and allowing yourself time to heal from the Cesarean delivery before getting pregnant again.

These tips may also come in handy if you want to try spontaneous labor and have a successful VBAC delivery:

  • Let your obstetrician or midwife know as soon as you decide that you want to attempt natural labor. If he or she is unsupportive, ask why (there may be strong medical reasons to avoid a VBAC). A supportive health professional may be essential to a successful VBAC delivery.

  • Arrange to give birth in a facility that has the proper monitoring equipment to keep you and your baby safe during labor and vaginal delivery.

  • Choose a hospital or birthing center that is able to provide a safe emergency Cesarean delivery if necessary.

  • Consider taking a childbirth class or hiring a birth coach to help prepare you for a vaginal delivery.

  • Follow a healthy diet and exercise regimen, according to the advice of your healthcare provider.

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