Pregnancy: Should I Try Vaginal Birth 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.
Pregnancy: Should I Try Vaginal Birth After a Past C-Section (VBAC)?
Get the facts
- Try vaginal birth 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 haven't 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. You'll need to talk about this with your doctor.
- VBAC has risks. The most serious one is that an old C-section scar could tear open during labor (uterine rupture). This is rare but can be very serious if it happens.
- A C-section is major surgery and has risks.
- Each added scar on the uterus from C-section or other surgery raises the chance of problems in the next pregnancy.
- Some hospitals and doctors don't offer VBAC.
Vaginal birth after cesarean (VBAC) is a vaginal childbirth after a woman has previously delivered a baby by cesarean section.
When you go into labor with the plan to deliver vaginally, it is called a "trial of labor after a cesarean," or TOLAC.
Having a vaginal birth after having a C-section can be a safe choice for most women. But it can have risks for both the mother and the baby. 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. The more C-sections you've had, the higher your risk (although it's still low) of the scar from your previous C-section tearing open during labor (uterine rupture) and problems with the placenta that may cause trouble during delivery.
- How many pregnancies you are planning. The chance of problems during future deliveries 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.
- Where you plan to deliver. If you want to try VBAC, it's a good idea to deliver in a place that has the staff and the equipment to do an emergency C-section at any time.
Benefits of VBAC include:
- Avoiding another scar on the uterus. If you are planning on a pregnancy after this one, scarring is an important thing to think about. Each additional scar on the uterus raises the risk of problems in a later pregnancy, such as placenta previa or placenta accreta.
- A lower risk of infection after childbirth.
- Greater participation in the birth.
- A quicker recovery.
- Lower costs.
Risks of VBAC include:
- Problems during labor that result in a cesarean delivery. This occurs with about 20 to 40 out of 100 women who try VBAC. But it doesn't happen with 60 to 80 out of 100 women who try VBAC.1
- Rupture of the scar on the uterus, which is rare but can be deadly to the mother and baby. Some of the things that can increase the chance of a rupture are a vertical incision used in a past C-section, the use of certain medicines to start (induce) labor, and many scars on the uterus from past C-sections or other surgeries.
- 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 vaginal births and after planned cesareans.2
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.
The risks of cesarean delivery include:
- 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.
- Breathing problems (respiratory distress syndrome) for the baby after birth if the due date has been miscalculated and a cesarean is done before the baby's lungs are fully developed.
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.
Your doctor might recommend a C-section instead of VBAC if:
- There is a medical reason to have a cesarean, for example, you have a placenta previa, or active genital herpes, or the baby is in a breech position.
- You have a vertical (classical) uterine incision from a past C-section.
- You have scars on your uterus from other surgeries.
- You've had a cesarean scar on your uterus break open (rupture) during labor in the past.
Compare your options
What is usually involved?
What are the benefits?
What are the risks and side effects?
- You try to have a vaginal birth.
- You may spend one or two nights in the hospital after you have 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.
- 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 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
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.
I'm not concerned about the risk of a uterine rupture.
I'm worried about a uterine rupture with VBAC.
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.
I want to have this baby vaginally so that I don't get another scar on my uterus.
If I want to have another baby, I won't mind how my baby is delivered.
I want a shorter recovery.
I don't mind a longer recovery.
My other important reasons:
My other important reasons:
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.
Having a C-section
What else do you need to make your decision?
Check the facts
Is it likely that you can give birth vaginally after having had a cesarean before?
- YesYou're right. Many women can have a vaginal birth after having had a cesarean before. This is especially true if you don't have the same problem in this pregnancy that led to the past C-section.
- NoSorry, that's not right. Many women can have a vaginal birth after having had a cesarean before. This is especially true if you don't have the same problem in this pregnancy that led to the past C-section.
- I'm not sureIt may help to go back and read "Get the Facts." Many women can have a vaginal birth after having had a C-section before.
If you try VBAC, might you still need to have a C-section?
- YesThat's right. If you try VBAC, you still may need to have a C-section. For example, your labor could stop, or the baby could have problems that require a C-section.
- NoSorry, that's not right. If you try VBAC, you still may need to have a C-section. For example, your labor could stop, or the baby could have problems that require a C-section.
- I'm not sureIt may help to go back and read "Get the Facts." Even if you try VBAC, you still may need to have a C-section. For example, your labor could stop, or the baby could have problems that require a C-section.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||Sarah Marshall, MD - Family Medicine|
|Specialist Medical Reviewer||Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology|
- American College of Obstetricians and Gynecologists (2010). Vaginal birth after previous cesarean delivery. ACOG Practice Bulletin No. 115. Obstetrics and Gynecology, 116(2): 450–463.
- Cunningham FG, et al. (2010). Prior cesarean delivery. In Williams Obstetrics, 23rd ed., pp. 565–576. New York: McGraw-Hill.
Last Updated:March 29, 2013