Before the 1970s, a woman could not choose to deliver vaginally after having a cesarean section. Pregnant women who had a previous cesarean had to schedule a repeat c section when giving birth again.
In the years since, vaginal birth after cesarean (VBAC) has become a safe option for many birthing people with a low risk of complications. The VBAC success rate in the U.S. is 60-80%.
A successful VBAC does not have the potential for surgical complications that a c section does. However, an unsuccessful trial of labor after cesarean (TOLC) is linked to different complications, including the risk of uterine rupture.
We’ve compiled information about important VBAC considerations as you explore your options for giving birth.
A successful VBAC has a shorter recovery period than a repeat c section. It also carries a lower risk for the potential surgical complications of a c section which include:
There is also a lower risk for health issues associated with multiple c sections including hysterectomy and problems with the placenta, which can impact the possibility of future pregnancies.
In addition, women may choose a VBAC to have the experience of vaginal delivery, which can be important to their birth plan.
However, a VBAC also has the potential for infection, blood loss, and other health issues. Although rare, a VBAC carries the risk of uterine rupture.
Your risk of this rare but serious complication depends significantly on the type of uterine scar you have from your previous cesarean.
There is also the less common t-shaped incision, which has a higher risk of uterine rupture, similar to a vertical incision.
You cannot determine which kind of uterine incision was used during your previous c section by looking at the outer scar on your abdomen, but medical records should have this information.
If you are interested in a VBAC, have your OB/GYN or another trusted healthcare professional review the records from your previous cesarean.
You have the right to choose your c section incision. If you are planning to have a c section but may want to deliver by VBAC in the future, discuss incision options with your OB/GYN.
Those planning to deliver vaginally can also include their preferences for a c section incision in their birth plan, in the event of an unplanned c section.
It’s harmful to look at VBAC risks and benefits as fixed, universal certainties. The balance of VBAC risks and benefits differ from one woman to another depending on factors like the type of uterine scar, but it can also shift throughout your pregnancy.
For example, labor induction can increase the possibility of complications during vaginal delivery and lower your chance of a successful VBAC.
Conversely, if you plan to have a repeat c section but go into early labor, a VBAC may be a better option depending on how far you are into labor and the health of your baby.
Your healthcare provider can help you understand whether a VBAC or repeat c section is better for your current pregnancy.
As you explore your options for delivering, you may encounter a tool called a VBAC calculator, which healthcare providers sometimes use to determine your chance of a successful VBAC.
In recent years, the VBAC calculator has been called into question for its use of race as a factor in predicting success. Do not hesitate to seek a second opinion if you have concerns about how you are evaluated for a VBAC.
To understand if you are a VBAC candidate, speak with your healthcare provider about:
In general, you have a higher chance of a successful VBAC if you’ve had two or fewer c sections with low transverse incisions and have no additional uterine scars, abnormalities, or previous uterine ruptures.
You are also more likely to be a candidate for a VBAC if:
Certain health conditions and pregnancy circumstances can prevent the possibility of a VBAC.
A VBAC may not be a safe option if any of the following applies:
Additionally, a VBAC may not be an option if any of the following applies:
For the best chance of a successful VBAC, discuss your options for both vaginal and c section delivery with your OB/GYN early in your pregnancy.
The conversation should help you understand the associated risks and benefits given your individual health history and pregnancy circumstances, as well as inform your provider of your birthing preferences.
Make sure that they have your complete medical history, including records of your prior c section and any other uterine surgeries or procedures.
Here are some topics to cover.
Certain risk factors may arise during your pregnancy so continue to communicate with your healthcare provider about delivery options as your pregnancy progresses.
You should revisit your plan for delivery at each late-term appointment (34 weeks and beyond). Make sure that both you and your provider are confident in your birthing facility’s ability to respond to complications during a VBAC.
Finally, stay flexible — it’s impossible to predict exactly how labor and childbirth will go, whether you plan to deliver vaginally or by c section.
To ensure the safety of both you and your baby, a VBAC should take place in a medical facility that is equipped to manage potential VBAC complications and provide emergency care.
When planning your VBAC, coordinate with your care team to evaluate your chosen location’s available resources.
If planning for a VBAC outside of a hospital setting, coordinate an emergency transportation strategy with your birthing team.
At Ruth Health, we understand that nobody knows what you need better than you. We provide expert, evidence-based maternal advice so that you can make the best decisions for yourself.
If a repeat c section is an appropriate choice for you, our c section recovery sessions provide emotional and physical support while you heal, starting as early as 24 hours postpartum. Learn more or book a session.
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