Choosing Between Vaginal Birth After C-section Or Repeat C-section

What is a vaginal birth after a cesarean section?

Vaginal birth after a cesarean section (VBAC) is when a baby is delivered through the vagina when a woman had a baby in the past by cesarean section (C-section). During a C-section, an incision (cut) is made through your abdomen and uterus. The baby is taken out through this opening.

What are my birth options after having a previous C-section?

  • Repeat C-section: After a previous cesarean section, you may be able to have your baby delivered by C-section again.

  • Vaginal birth: You may be able to deliver your baby through your vagina.

What factors may increase my chances of having a vaginal birth after having a previous C-section?

  • Caregivers may learn where the cut was made in your uterus during your C-section. If the cut was made through the lower part of your uterus, you may have a greater chance of having a vaginal delivery. If you have had no other surgery done on your uterus, your chance of having a vaginal birth may be higher. If your pregnancy is normal, your chance of having a vaginal delivery is higher. Infections such as genital herpes, or problems with your pregnancy may decrease your ability to give birth vaginally.

  • If you are under 40 years old, your chances of successfully giving birth vaginally are greater. If you have had babies one or more times vaginally before this pregnancy, your chance of success increases. If your labor begins on its own (without the help of caregivers or medicines), you have a greater chance of having a successful vaginal birth.

What factors may decrease my chances of having a successful vaginal birth after having a previous C-section?

  • If you have had more than one C-section in the past, your chances of delivering your baby vaginally may decrease. If caregivers tell you that you are having a large baby (greater than four kilograms), or nine pounds) you may be less likely to be able to have a vaginal delivery. If your pregnancy has gone past the date that your baby was to be born (pregnancy that is over 40 weeks duration) you may not be able to deliver vaginally.

  • If you weigh more than caregivers suggest, smoke cigarettes, or drink alcohol, you may be less able to have a vaginal birth. Alcohol is found in adult drinks such as beer, wine and whiskey. If your unborn baby is in breech position (bottom facing down instead of head down), this decreases your chance of having a vaginal birth.

What are some of the benefits of giving birth vaginally?

  • Fast recovery: You can often go home soon after having a vaginal birth. There may be less pain, and the pain may go away sooner if you give birth through the vagina. Your body may recover quickly, and you may be able to do your usual activities soon after having your baby.

  • Decreased and different risks: Infection and injury to your body organs are less likely with a vaginal delivery. The risk of heavy bleeding during your delivery may be less with a vaginal delivery. You may be able to walk around sooner after a vaginal delivery. This may decrease the risk of blood clots forming in your blood vessels (deep vein thrombosis).

  • Emotional benefits and the support of others: Having a vaginal birth gives you an active part in your labor and delivery. More people, such as family and friends, may be allowed in the room with you while you have your baby. Some women feel that having a vaginal birth is the more natural way to have a baby.

What are some of the risks of having a vaginal birth after having a previous C-section?

  • The scar (healed cut) on your uterus from your previous C-section may break open during the delivery. If this happens, you will need to have a C-section. If your uterine scar opens up, you may bleed heavily. Blood loss can be very dangerous for you and your baby. Caregivers may need to do a hysterectomy. This surgery is done to remove your uterus. After having a hysterectomy, you would not be able to get pregnant again.

  • You may try to have your baby with a vaginal delivery, but the birth may not go as planned. If this happens, you may need to have an urgent C-section. Talk to your caregiver about this possibility, and ask him to explain the risks of an urgent C-section for you and for your baby.

  • Medicine may be used to begin or speed up a woman's labor. The risk of the incision made during your previous C-section coming open during your vaginal delivery is higher when this medicine is used. Caregivers will avoid giving you this medicine if you have had a previous C-section.

  • Delivering a baby through your vagina may weaken your pelvic floor muscles. Weak pelvic floor muscles can cause problems such as urine leaking when you cough, laugh and exercise. This problem may be short-term or long-lasting.

What are some of the benefits of having a C-section?

  • The date and time of a C-section may be planned ahead. If it is planned, you may be able to arrange it to fit your schedule and the schedules of others. You can also let others know the date and time that your baby will be born in advance.

  • You may be able to have caregivers do a tubal ligation procedure at the same time as the C-section. This procedure prevents future pregnancies. Ask your caregiver for more information about tubal ligation if you may not want to have any more children.

What are some of the risks of having a C-section?

  • If you are unable to walk around right away after the C-section, you are at a risk of getting blood clots in your legs. There is a chance that you will bleed more than expected from the surgery area, or you may get an infection. Your internal organs, such as your bowel (intestine) or bladder may be injured during the C-section.

  • If you have had more than one C-section, your risk of getting placenta previa in future pregnancies increases. Placenta previa is when your placenta covers your cervix (opening of your uterus). This condition can cause bleeding, and may lead to problems with your unborn baby.

If I choose to try to have a vaginal birth, what can I do to help prepare for it?

  • Learn as much as you can about having a vaginal birth. Talk to other women who have had a vaginal birth after having had a previous C-section. Talk to your caregiver and ask any questions that you may have.

  • Talk to your caregiver about diet and exercise. Caregivers may suggest that you do regular exercise, such as walking. You may need to change your diet to get the right nutrition for you and your unborn baby. Ask your caregiver for help choosing the best diet and exercise plans for you.

  • Take childbirth classes. You may be worried about going through labor and having a vaginal delivery. You and the person that you may want to have with you for the birth of your baby may want to attend childbirth classes together. These classes can teach you what to expect. Childbirth classes may help you feel more in control while you are going through labor and while delivering your baby. Ask your caregiver when and where you may be able to attend these classes.

  • Know the signs of labor. You will need to go to hospital when your labor pains are strong and coming more often. If you have watery or bloody fluid coming from your vagina, you should go to the hospital quickly. Have an overnight bag packed and ready to take with you. Ask your caregiver for more information about early labor signs, and the labor process.

Care Agreement

You have the right to help plan your care. To help with this plan, you must learn about your childbirth options. Work with caregivers to decide what option may be best for you.The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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