Vaginal Birth After Cesarean (VBAC)

Did you have a C-section during a previous labor, but would like to experience a vaginal birth in the future? The good news is that you may be able to have a vaginal birth after cesarean, also called a VBAC — and in fact, your doctor might recommend it. The American College of Obstetricians and Gynecologists’ (AGOG) VBAC guidelines encourage doctors to consider VBACs for women who meet the criteria, rather than the elective surgery of C-sections.

If you're thinking about a VBAC, there are ways to predict fairly well whether it might be a wise choice for you depending on your medical history and your pregnancy. So, chat with your practitioner about the decision.

Here’s more about VBACs to help you determine whether you’re a good candidate, as well as the benefits and potential risks of this procedure.

What is a VBAC?

If you had a past C-section, your next baby can be scheduled the same way, or you can attempt a vaginal delivery. Attempting this has another alphabet-soup name: TOLAC, or trial of labor after cesarean. If your TOLAC results in a baby born vaginally, then you’ve just had a VBAC.

Can you have a vaginal birth after a C-section?

Yes, if you meet the criteria for a TOLAC, a VBAC is generally recommended as a safe way to avoid more surgery — and the numbers confirm this guideline. In 2013, the most recent year data was available, the success rate for women in the U.S. who tried for a VBAC after a prior C-section was 70 percent.

And a VBAC may be smart if you want to have multiple kids. If you're pregnant with your second or third child and you know you want more wee ones down the line, a VBAC might be wise because elective C-sections become more dangerous the more you have them. Plus, if you have a successful VBAC now, your chance of another successful VBAC goes up, too.

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Who is a good candidate for a VBAC?

Talk with your doctor if you’re wondering whether it might be possible to have your next baby via VBAC and then take a look at these various scenarios based on health and birth history. You may be a good candidate for a VBAC if: 

• You’re in good health. If your baby isn’t overly large and you don’t have any pregnancy complications, a VBAC is a good possibility.
• You’ve had a vaginal birth. Research suggests that if you’ve already delivered a baby vaginally — even if it was before your C-section — your likelihood of having a safe and successful VBAC is more than 86 percent.
• Your labor starts spontaneously. Inductions don't work that well for VBACs, in part because doctors can't use as many labor-inducing medicines on women with uterine scars. What’s more, induction ups your risk for uterine rupture. This doesn’t mean VBAC inductions can't be done, but if you’re laboring on your own and progressing, a VBAC may be more likely.
• You had a low-transverse uterine incision. The kind of C-section cut you had matters. This side-to-side type, which is also called a bikini cut, is made low on the uterus and is the most common — and it’s also associated with a lower risk of rupture in future births.
• You’re young. One study reported that compared to women aged 21 to 34, those over 35 were 14 percent more likely to have an unsuccessful VBAC, and older women experienced 39 percent more risk of VBAC-related complications.

Who isn’t a good candidate for a VBAC?

On the flip side, you don’t qualify for a VBAC if you have the following in your medical history:

• Your incision was low or high vertical. These up-and-down incisions are more likely to result in uterine rupture than low-transverse uterine scars.
• You had a uterine rupture or uterine surgery. A prior rupture in pregnancy is rare, but it’s a no-go if you’d like to try for a VBAC.
• You have certain complications. Some health conditions and complications may make a C-section necessary, as can having a baby with heart rate problem or one who’s lying sideways in the uterus.
• You've gained a higher amount of weight during pregnancy. A recent study reported that VBAC success was 40 percent lower among women who gained more than 40 pounds during pregnancy compared to women who gained less than that amount.
• Your last baby was born recently. If it has been fewer than 6 to 12 months since your last delivery, which is called a short interpregnancy interval, a VBAC isn’t recommended.
• Your baby is large. Recent research has found the chance of VBAC failure is 50 percent higher when babies weigh more than 8 pounds 13 ounces at delivery compared to when they weigh less than 7 pounds 11 ounces. 
• You’re past your due date. A delivery date that comes and goes can mean the baby is getting too big — and VBACs with large babies may also increase the risk of uterine rupture and perineal tears — which is part of the reason why some doctors don't perform VBACs on women who are more than a week past their due date. 
• You’re having triplets. A VBAC can be tried with twins with a prior low-transverse C-section, but this procedure may not be offered if you’re carrying three (or more) babies.
• Your hospital or birthing center can’t perform an immediate C-section. No matter your medical status, all pregnant women are discouraged from attempting a VBAC outside of a hospital setting. The reason? Most VBACs are uncomplicated and mother and baby do well, but life-threatening situations can develop if not addressed right away, so access to a fully equipped medical center is recommended. 

As for women who’ve already had two C-sections, if both involved low-transverse uterine incisions, then some practitioners may offer the VBAC option. However, many health care providers won’t attempt it if this is the case. Bottom line: check with your doctor.

How can you prepare for a VBAC?

If you do push for pushing and your doctor agrees, make sure you discuss the use of prostaglandins (not using them or other hormones to stimulate labor, which can affect the risk of uterine rupture), along with labor pain medication.

Know that epidurals do not affect the chances for a successful VBAC. In fact, many doctors recommend epidurals early on during labor to eliminate the need for general anesthesia in the event that an emergency C-section becomes necessary (general anesthesia is riskier for pregnant women than an epidural is).

Keep in mind that your course of labor can change at any time, especially if you need to be induced, which can reduce your chances of a vaginal delivery and up the risk of complications. But the opposite can also happen: If you go into labor before your scheduled C-section, your surgery date may be tossed out the window and a VBAC could occur if labor goes well and the baby is healthy.

Flexibility is the key here, as is learning as much as you can about the VBAC process. To do this, take a childbirth education class even if you've had one before so you’re as prepared as possible.

What are the benefits of a VBAC?

A good outcome is on your side: A successful VBAC is often the safest way for women who’ve had a prior C-section to deliver their next baby, and VBACs are successful 60 to 80 percent of the time. Other benefits to having a VBAC include the following:

• No surgery. A C-section is a major abdominal operation, whereas a VBAC costs less, is less likely to result in infection, is associated with less blood loss and will lower your risk of blood clotting.
• Fewer complications. A VBAC can decrease the risk of complications such as blood clots or injury to surrounding organs. (However, if you do have a C-section, know that complications are very rare.)
• Faster recovery. A C-section can lay you low for several weeks as your incision heals, but a vaginal birth will allow you to leave the hospital and be up and around sooner.
• Easier future pregnancies. As mentioned, if you hope to have a big brood, a VBAC can help you avoid the risks of multiple cesareans, like placenta previa or placenta accreta.

What are the possible risks of a VBAC?

The biggest risk of a VBAC is that it ultimately won't be successful and you'll be forced to give birth via emergency C-section; an emergency cesarean after a VBAC is considered one of the riskiest ways to deliver a baby. That scenario can happen for many reasons — your labor doesn't progress, perhaps, or there's evidence of fetal distress. 

One of most problematic causes of a failed VBAC is uterine rupture, which is when the scar on your uterus from your previous C-section re-opens during labor, putting you and your baby at serious risk. Fortunately, it’s very rare: only one in 100 women who attempts a VBAC will rupture this way.