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Pregnancy: Should I try vaginal childbirth after a past C-section (VBAC)?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

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Pregnancy: Should I try vaginal childbirth after a past C-section (VBAC)?

1

Get the
Facts

2

Compare
Options

3

Your
Feelings

4

Your
Decision

5

Quiz
Yourself

6

Your
Summary

Get the facts

Your options

Try labor after having had a past cesarean section (C-section).
Have another C-section.

Key points to remember

Many women can have a vaginal birth after having had a C-section in the past. This is called vaginal birth after cesarean (VBAC). If the problem that led to the C-section (such as breech position) doesn't happen in this pregnancy, you are about as likely to have a vaginal birth as women who have not had a C-section.
You still may need to have a C-section after trying VBAC.
Whether VBAC is right for you depends on any risk factors you have that could make it unsafe.
During VBAC, there is a slight risk of an old C-section scar on the uterus tearing open. This is called uterine rupture. This risk increases with each added scar and with the use of medicine to start labor. If you have had one or two C-sections but have also delivered vaginally before, your chance of a uterine rupture is much lower than if you had never given birth vaginally.
A C-section is major surgery and has risks.
Each added scar on the uterus raises the chance of placenta problems in the next pregnancy.
Some hospitals and doctors don't offer VBAC.

FAQs

What is a VBAC?

A vaginal birth after cesarean, or VBAC, is a choice for many women who have had:¹

One C-section.
One or two C-sections and a past vaginal birth.

When you go into labor with the plan to deliver vaginally, it is called a "trial of labor."

Is VBAC a good choice for you?

Having a vaginal birth after having one C-section—or after two C-sections and a past vaginal birth—is a safe choice for most women. Whether it is right for you depends on several things, including:

Why you had a C-section before. If you had a C-section because of a problem that you now have again (such as a breech baby), a trial of labor is generally not recommended. But most women have C-sections because of problems that happen during labor (not before), such as labor that stops or problems with the baby. Usually there is no reason to expect that the same problem will happen again, although it may.
How many C-sections you've had. If you've had one C-section, a trial of labor is usually safe. If you've had two C-sections, a trial of labor is only considered safe if you've also had a vaginal birth before. A trial of labor is not recommended for women who've had more than two C-sections. The more C-sections you've had, the higher your risk (although it's still low) of uterine rupture and problems with the placenta that may cause trouble during delivery.
How many pregnancies you are planning. The chance of problems during pregnancy and surgery increases with the number of C-section scars you have.
What you want. If there is no health reason to have a C-section, the choice is yours.
The hospital where you will deliver. To offer VBAC, a hospital must have the staff and the equipment to do an emergency C-section at any time.

What are the risks of VBAC?

Risks of VBAC include:

A problem during labor (such as labor that stops or problems with the baby) that requires an emergency C-section. This occurs with about 20 to 40 out of 100 women who try VBAC. But it doesn't happen with 60 to 80 women who try VBAC.¹
Uterine rupture, which is rare but can be deadly to the mother and baby. A vertical incision used in a past C-section is one of the things that can increase the chance of a rupture.
The chance of infection. Women who have a trial of labor and end up having a C-section have a higher risk of infection. This means that the risk of infection is lower after a vaginal birth and after a repeat cesarean without labor.¹

No two births are alike. You and your doctor can't fully control labor and delivery. So no doctor can say for sure that you will be able to have a vaginal birth.

What are the risks of a cesarean delivery?

The risks of cesarean delivery include:

Infections.
Blood loss that requires a blood transfusion.
Genital or urinary problems.
Blood clots.
Risks from anesthesia.
A longer recovery time.
Injury to the baby during the delivery. The injury usually isn't serious.

Future risks

If you are planning to get pregnant again, it's important to think about scarring. After you have two C-section scars, each added scar in the uterus raises the risk of placenta problems in a later pregnancy. These problems include placenta previa and placenta accreta, which raise the risk of problems for the baby and your risk of needing a hysterectomy to stop bleeding.²

Why might your doctor recommend VBAC?

Your doctor might recommend VBAC if:

You have one C-section scar, or you have two C-section scars and also have had a vaginal birth.
You are planning to have more pregnancies after this one.
You don't have a problem (such as the baby in a breech position) that would make it hard to have a vaginal birth.
You don't have a type of C-section scar that raises the chance of a uterine rupture.
Your doctor and hospital offer VBAC.

Compare your options

Compare


What is usually involved?
What are the benefits?
What are the risks and side effects?

Try VBAC Try VBAC

You try to have a vaginal birth.
You may spend one or two nights in the hospital after having your baby.
If you or the baby has problems, you may need to have a C-section.

You avoid another scar on your uterus.
Vaginal birth helps squeeze fluid from your baby's lungs. This helps the baby breathe after birth.
You spend less time in the hospital and less time recovering.

The scar from a past C-section could rupture. This is rare but very serious.
The chance of an infection increases if you try to give birth vaginally and then need a C-section.

Have a C-section Have a C-section

Your baby is delivered through surgery.
You may be awake but numb for the birth, or you may be asleep.
You probably will spend about 3 days in the hospital after having your baby.
You'll need 4 to 6 weeks to recover.

It may be the safest choice if you or your baby has a problem.
You have a lower risk of uterine rupture than with VBAC.
You can schedule the day and time of delivery with your doctor.

There is a chance that your baby could be injured during the birth.
Your baby could need special care in the neonatal intensive care unit (NICU) if he or she has breathing trouble because of fluid in the lungs.
You have the risks of major surgery, which can include bleeding and infection.
A C-section adds a scar to your uterus. Each added scar increases the risk of a problem with the placenta in a future pregnancy.

Personal Stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about the decision to have a VBAC trial of labor

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I believe I had a more difficult time bonding with my first baby in the first week because of the cesarean delivery (she was a breech birth). A lot of my energy was taken up with recovering from the surgery, both physically and emotionally. I'm planning a trial of labor for my second baby. My husband and I are really hopeful that things go well, especially since we plan to have a big family. If I can, I want to avoid the risks of having a scarred-up uterus from several cesareans.

Amber, age 29

I had my first child by cesarean after more than 30 hours of hard labor and a lot of pain. I am willing to go through another cesarean to avoid that experience again. I know that recovering from the surgery isn't easy either, but I prefer that option. And this is our last baby, so I don't have to worry about the risks of pregnancy with multiple cesarean scars.

Gretchen, age 27

During my first pregnancy, I developed placenta previa and had to have a cesarean. I have talked to my doctor and my husband and read up on all the risks of a trial of labor for someone in my situation. My doctor tells me that as long as another placenta previa doesn't develop, there is no obvious reason why I shouldn't be able to try a vaginal birth this time. I hope it goes well, because if I have another cesarean, I won't have the option of trying a vaginal birth the next time!

Marcia, age 35

My first cesarean was done because the baby was in distress. That experience was so scary for me that I don't want to repeat it. My doctor says there's no reason to expect that it will happen again this time, but she also can't say for sure that it won't happen. She says the decision is up to me, and I'm choosing to have another cesarean.

Graciella, age 31

If you need more information, see the topics:

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to try VBAC

Reasons to have a C-section

I want to participate more in my baby's birth.

I'll feel like I'm involved in the birth no matter how my baby arrives.

More important

Equally important

More important

I'm not concerned about the risk of a uterine rupture.

I'm worried about a uterine rupture with VBAC.

More important

Equally important

More important

I'm worried about a risk to my baby from a C-section.

I'm more worried that something could happen to my baby with VBAC.

More important

Equally important

More important

I want to have another baby vaginally, so I don't want another scar on my uterus.

If I want to have another baby, I won't mind how my baby is delivered.

More important

Equally important

More important

I want a shorter recovery.

I don't mind a longer recovery.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Trying VBAC

Having a C-section

Leaning toward

Undecided

Leaning toward

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision

Next Steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts

Key concepts that you understood

Key concepts that may need review

Getting ready to act

Patient Choices

What matters to you

Credits and references

Credits

Author	Sandy Jocoy, RN
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Sarah Marshall, MD - Family Medicine
Specialist Medical Reviewer	Kirtly Jones, MD - Obstetrics and Gynecology

References

Citations

American College of Obstetricians and Gynecologists (2004, reaffirmed 2007). Vaginal birth after previous cesarean delivery. ACOG Practice Bulletin No. 54. Obstetrics and Gynecology, 104(1): 203–212.
Paré E, et al. (2005). Vaginal birth after caesarean section versus elective repeat caesarean section: Assessment of maternal downstream health outcomes. British Journal of Obstetrics and Gynaecology, 113(1): 75–85.

Pregnancy: Should I try vaginal childbirth after a past C-section (VBAC)?

You can use this information to talk with your doctor or loved ones about your decision.

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?

1. Get the Facts

Your options

Try labor after having had a past cesarean section (C-section).
Have another C-section.

Key points to remember

Many women can have a vaginal birth after having had a C-section in the past. This is called vaginal birth after cesarean (VBAC). If the problem that led to the C-section (such as breech position) doesn't happen in this pregnancy, you are about as likely to have a vaginal birth as women who have not had a C-section.
You still may need to have a C-section after trying VBAC.
Whether VBAC is right for you depends on any risk factors you have that could make it unsafe.
During VBAC, there is a slight risk of an old C-section scar on the uterus tearing open. This is called uterine rupture. This risk increases with each added scar and with the use of medicine to start labor. If you have had one or two C-sections but have also delivered vaginally before, your chance of a uterine rupture is much lower than if you had never given birth vaginally.
A C-section is major surgery and has risks.
Each added scar on the uterus raises the chance of placenta problems in the next pregnancy.
Some hospitals and doctors don't offer VBAC.

FAQs

What is a VBAC?

A vaginal birth after cesarean, or VBAC, is a choice for many women who have had:¹

One C-section.
One or two C-sections and a past vaginal birth.

When you go into labor with the plan to deliver vaginally, it is called a "trial of labor."

Is VBAC a good choice for you?

Having a vaginal birth after having one C-section—or after two C-sections and a past vaginal birth—is a safe choice for most women. Whether it is right for you depends on several things, including:

Why you had a C-section before. If you had a C-section because of a problem that you now have again (such as a breech baby), a trial of labor is generally not recommended. But most women have C-sections because of problems that happen during labor (not before), such as labor that stops or problems with the baby. Usually there is no reason to expect that the same problem will happen again, although it may.
How many C-sections you've had. If you've had one C-section, a trial of labor is usually safe. If you've had two C-sections, a trial of labor is only considered safe if you've also had a vaginal birth before. A trial of labor is not recommended for women who've had more than two C-sections. The more C-sections you've had, the higher your risk (although it's still low) of uterine rupture and problems with the placenta that may cause trouble during delivery.
How many pregnancies you are planning. The chance of problems during pregnancy and surgery increases with the number of C-section scars you have.
What you want. If there is no health reason to have a C-section, the choice is yours.
The hospital where you will deliver. To offer VBAC, a hospital must have the staff and the equipment to do an emergency C-section at any time.

What are the risks of VBAC?

Risks of VBAC include:

A problem during labor (such as labor that stops or problems with the baby) that requires an emergency C-section. This occurs with about 20 to 40 out of 100 women who try VBAC. But it doesn't happen with 60 to 80 women who try VBAC.¹
Uterine rupture, which is rare but can be deadly to the mother and baby. A vertical incision used in a past C-section is one of the things that can increase the chance of a rupture.
The chance of infection. Women who have a trial of labor and end up having a C-section have a higher risk of infection. This means that the risk of infection is lower after a vaginal birth and after a repeat cesarean without labor.¹

No two births are alike. You and your doctor can't fully control labor and delivery. So no doctor can say for sure that you will be able to have a vaginal birth.

What are the risks of a cesarean delivery?

The risks of cesarean delivery include:

Infections.
Blood loss that requires a blood transfusion.
Genital or urinary problems.
Blood clots.
Risks from anesthesia.
A longer recovery time.
Injury to the baby during the delivery. The injury usually isn't serious.

Future risks

If you are planning to get pregnant again, it's important to think about scarring. After you have two C-section scars, each added scar in the uterus raises the risk of placenta problems in a later pregnancy. These problems include placenta previa and placenta accreta, which raise the risk of problems for the baby and your risk of needing a hysterectomy to stop bleeding.²

Why might your doctor recommend VBAC?

Your doctor might recommend VBAC if:

You have one C-section scar, or you have two C-section scars and also have had a vaginal birth.
You are planning to have more pregnancies after this one.
You don't have a problem (such as the baby in a breech position) that would make it hard to have a vaginal birth.
You don't have a type of C-section scar that raises the chance of a uterine rupture.
Your doctor and hospital offer VBAC.

2. Compare Options

	Try VBAC	Have a C-section
What is usually involved?	You try to have a vaginal birth. You may spend one or two nights in the hospital after having your baby. If you or the baby has problems, you may need to have a C-section.	Your baby is delivered through surgery. You may be awake but numb for the birth, or you may be asleep. You probably will spend about 3 days in the hospital after having your baby. You'll need 4 to 6 weeks to recover.
What are the benefits?	You avoid another scar on your uterus. Vaginal birth helps squeeze fluid from your baby's lungs. This helps the baby breathe after birth. You spend less time in the hospital and less time recovering.	It may be the safest choice if you or your baby has a problem. You have a lower risk of uterine rupture than with VBAC. You can schedule the day and time of delivery with your doctor.
What are the risks and side effects?	The scar from a past C-section could rupture. This is rare but very serious. The chance of an infection increases if you try to give birth vaginally and then need a C-section.	There is a chance that your baby could be injured during the birth. Your baby could need special care in the neonatal intensive care unit (NICU) if he or she has breathing trouble because of fluid in the lungs. You have the risks of major surgery, which can include bleeding and infection. A C-section adds a scar to your uterus. Each added scar increases the risk of a problem with the placenta in a future pregnancy.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

If you need more information, see the topics:

Personal stories about the decision to have a VBAC trial of labor

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I believe I had a more difficult time bonding with my first baby in the first week because of the cesarean delivery (she was a breech birth). A lot of my energy was taken up with recovering from the surgery, both physically and emotionally. I'm planning a trial of labor for my second baby. My husband and I are really hopeful that things go well, especially since we plan to have a big family. If I can, I want to avoid the risks of having a scarred-up uterus from several cesareans."

— Amber, age 29

"I had my first child by cesarean after more than 30 hours of hard labor and a lot of pain. I am willing to go through another cesarean to avoid that experience again. I know that recovering from the surgery isn't easy either, but I prefer that option. And this is our last baby, so I don't have to worry about the risks of pregnancy with multiple cesarean scars."

— Gretchen, age 27

" During my first pregnancy, I developed placenta previa and had to have a cesarean. I have talked to my doctor and my husband and read up on all the risks of a trial of labor for someone in my situation. My doctor tells me that as long as another placenta previa doesn't develop, there is no obvious reason why I shouldn't be able to try a vaginal birth this time. I hope it goes well, because if I have another cesarean, I won't have the option of trying a vaginal birth the next time! "

— Marcia, age 35

"My first cesarean was done because the baby was in distress. That experience was so scary for me that I don't want to repeat it. My doctor says there's no reason to expect that it will happen again this time, but she also can't say for sure that it won't happen. She says the decision is up to me, and I'm choosing to have another cesarean."

— Graciella, age 31

3. Your Feelings

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to try VBAC

Reasons to have a C-section

I want to participate more in my baby's birth.

I'll feel like I'm involved in the birth no matter how my baby arrives.

More important

Equally important

More important

I'm not concerned about the risk of a uterine rupture.

I'm worried about a uterine rupture with VBAC.

More important

Equally important

More important

I'm worried about a risk to my baby from a C-section.

I'm more worried that something could happen to my baby with VBAC.

More important

Equally important

More important

I want to have another baby vaginally, so I don't want another scar on my uterus.

If I want to have another baby, I won't mind how my baby is delivered.

More important

Equally important

More important

I want a shorter recovery.

I don't mind a longer recovery.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Your Decision

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Trying VBAC

Having a C-section

Leaning toward

Undecided

Leaning toward

Credits and references

Credits

Author	Sandy Jocoy, RN
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Sarah Marshall, MD - Family Medicine
Specialist Medical Reviewer	Kirtly Jones, MD - Obstetrics and Gynecology

References

Citations

American College of Obstetricians and Gynecologists (2004, reaffirmed 2007). Vaginal birth after previous cesarean delivery. ACOG Practice Bulletin No. 54. Obstetrics and Gynecology, 104(1): 203–212.
Paré E, et al. (2005). Vaginal birth after caesarean section versus elective repeat caesarean section: Assessment of maternal downstream health outcomes. British Journal of Obstetrics and Gynaecology, 113(1): 75–85.

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Last Updated:April 17, 2009

Author:Sandy Jocoy, RN

Medical Review:Sarah Marshall, MD - Family Medicine & Kirtly Jones, MD - Obstetrics and Gynecology

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