Vaginal birth after cesarean (VBAC): What to know - Ruth Health

Vaginal birth after cesarean (VBAC): What to know

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Fast facts: 

  • Vaginal birth after cesarean (VBAC) is a safe option for women with a low risk of complications.
  • A successful VBAC doesn’t have the same potential for surgical complications as a c section, but there is the risk of uterine rupture.
  • The balance of VBAC risks and benefits varies from one woman to another depending on factors like the type of uterine scar from the previous c section.
  • A healthcare provider can help you understand if you are a candidate for a VBAC based on your health history and individual risk factors.

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.

What are the risks and benefits of a VBAC?

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:

  • excessive bleeding
  • infection
  • blood clotting

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 are three primary possibilities.

  • A low vertical incision, which runs vertically in the lower, thinner part of the uterus, carries a higher risk of uterine rupture than a low transverse incision.
  • A high vertical, or “classical,” incision, which runs vertically in the upper part of the uterus, has the highest risk of uterine rupture. It is sometimes used in very preterm c sections and unusually small babies.
  • A low transverse incision, which runs horizontally across the lower, thinner part of the uterus, is the most common uterine incision used in a c section and the least likely to rupture. 

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.

Is a VBAC better than a repeat 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.

Am I a candidate for a VBAC?

To understand if you are a VBAC candidate, speak with your healthcare provider about:

  • Your individual health history
  • Current pregnancy circumstances
  • The reason(s) for your previous c section(s)

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: 

  • The reason for your previous c section does not apply to this pregnancy
  • You have no significant health issues
  • Your baby is an average size in a head-down position

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:

  • You have a health condition linked to complications with vaginal delivery such as diabetes or high blood pressure, or a sexually transmitted infection that could potentially be passed to your baby during vaginal delivery.
  • You’ve experienced complications during your current pregnancy such as placenta previa, which can lead to excessive bleeding during vaginal delivery.
  • You had a high vertical uterine incision during a previous c section.
  • You experienced a uterine rupture.

Additionally, a VBAC may not be an option if any of the following applies:

  • You’ve had more than two previous c sections.
  • You underwent any type of previous uterine surgery, including fibroid removal.
  • You have a body mass index (BMI) of 50 or higher and have never given birth vaginally.
  • You are pregnant with triplets or higher-order multiples.

How can I have a successful VBAC?

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.

  • Previous pregnancies and deliveries
  • Reason(s) for your previous c section(s)
  • Risks and benefits of a VBAC given your health history and current pregnancy 
  • Risks and benefits of a repeat c section given your health history and current pregnancy 
  • A plan for inducing labor
  • Hospital or medical facility resources
  • Your family building goals beyond this pregnancy
  • Your physical health and recovery goals

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.

Where can I have a VBAC?

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.

Here for you during pregnancy and beyond

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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