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VBAC: Know the pros and cons

Many women are candidates for vaginal birth after cesarean (VBAC). In fact, research on women who attempt a trial of labor after cesarean (TOLAC) shows that about 60 to 80 percent have a successful vaginal delivery. Still, the choice to pursue VBAC or schedule a repeat C-section can be difficult. Here's insight on how to make the decision.

Medically reviewed on Jun 30, 2018

Why consider VBAC?

Compared with having another C-section, a vaginal delivery involves no surgery, none of the possible complications of surgery, a shorter hospital stay and a quicker return to normal daily activities. VBAC might also be appealing if you want to experience vaginal childbirth.

It's important to consider future pregnancies, too. If you're planning for more pregnancies, VBAC might help you avoid the risks of multiple cesarean deliveries, such as placental problems.

What are the risks of VBAC?

While VBAC is associated with fewer complications than an elective repeat C-section, a failed trial of labor after a C-section is associated with more complications, including, rarely, a uterine rupture. During a uterine rupture, the uterus tears open. An emergency C-section is needed to prevent complications, such as heavy bleeding for the mother and life-threatening injury to the baby. Sometimes, the uterus might need to be removed (hysterectomy) to stop the bleeding. If your uterus is removed, you won't be able to get pregnant again.

Can you put the risk of uterine rupture into perspective?

Uterine rupture is rare, happening in fewer than 1 percent of women who attempt a trial of labor after cesarean. If you're considering VBAC, make sure that the facility where you'll deliver the baby is ready to deal with a uterine rupture. You'll need staff immediately available to provide emergency care.

Who's eligible for VBAC?

VBAC eligibility depends on many factors. For example:

  • Have you had previous vaginal deliveries? A vaginal delivery at least once before or after your prior C-section increases the probability of a successful VBAC.
  • What type of uterine incision was used for the prior C-section? Most C-sections use a low transverse incision. Women who have had a low transverse or low vertical incision are usually VBAC candidates. If you've had a prior high vertical (classical) incision, VBAC isn't recommended because of the risk of uterine rupture.
  • How many C-sections have you had? Some health care providers won't offer VBAC if you have had more than two prior C-sections.
  • When was your last C-section? The risk of uterine rupture is higher if you attempt VBAC less than 18 months after having a C-section.
  • Do you have any health concerns that might affect a vaginal delivery? A C-section might be recommended if you have placental problems, your baby is in an abnormal position, or you're carrying triplets or higher order multiples.
  • Where will you deliver the baby? Plan to deliver at a facility equipped to handle an emergency C-section. A home delivery isn't appropriate for VBAC.
  • Will you need to be induced? Having labor induced or augmented decreases the likelihood of a successful VBAC.
  • Have you ever had a uterine rupture? If so, you're not a candidate for VBAC.

How does labor and delivery during VBAC differ from labor and delivery during a routine vaginal birth?

If you choose VBAC, when you go into labor you'll follow a process similar to that used for any vaginal delivery. However, your health care provider will likely recommend continuous monitoring of your baby's heart rate and be prepared to do a repeat C-section if needed.

What other advice do you offer women who are considering VBAC?

If you're considering VBAC, discuss the option, your concerns and expectations with your health care provider early in pregnancy. Make sure he or she has your complete medical history, including records of your previous C-section and any other uterine procedures. Your health care provider might calculate the likelihood that you'll have a successful VBAC. It's important to continue discussing the risks and benefits of VBAC throughout pregnancy, especially if certain risk factors arise.

Find out about the VBAC policy at the facility where you'll deliver your baby, but try to stay flexible. The circumstances of your labor could make VBAC a clear choice or, after counseling, you and your health care provider might decide that a repeat C-section would be best after all.

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