Vaginal Birth After Cesarean (VBAC)

Is VBAC Right for You?

Whether a VBAC is right for you depends on if you have any risk factors (things that increase your risk) that could make it unsafe. It also depends on how likely it is that a VBAC will be successful for you. You'll need to talk about this with your doctor.

Here are some things to think about when considering a VBAC.

Why would you have a VBAC?

• You want to experience a vaginal birth.
• You want to lower the chances that your baby will have breathing problems after delivery.
• You feel that the benefits of vaginal birth outweigh the small risk that the scar on your uterus may break open during labor. If a scar breaks open, it can be very dangerous for both you and your baby.
• You want to avoid another scar on the uterus. Each added scar can cause problems with the placenta during a future pregnancy.

Why would you not be able to have a VBAC?

• Your hospital doesn't offer VBAC.
• You are at greater risk of your uterus tearing because:
  • The scar on your uterus is vertical.
  • You've had more than two cesareans.
  • You are carrying triplets or more.
• The likelihood is low that a VBAC will work for you. Your doctor may use a special calculator to figure out how likely it is that a VBAC will succeed.
• You have a placenta problem or another medical issue that could make a vaginal birth risky.
• Something happens during your pregnancy or labor that requires a cesarean. For example:
  • You develop a problem with your blood pressure.
  • Your baby isn't head-down.
  • Your labor isn't progressing well.
  • Your baby is having problems.

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What To Expect

A trial of labor after cesarean, or TOLAC, is the same as normal labor. But you and the baby will be watched more closely. During early labor, you can be as active as you want. There are no specific limits for TOLAC until active labor starts. During the active part of labor, electronic fetal monitoring is used to watch for early signs of problems.

If you are doing a trial of labor and you've never had a vaginal birth, your labor will be like a first-time labor. This is also true if your previous cesarean was done early in labor.

Medicines for starting or strengthening a trial of labor

As the end of pregnancy nears, the cervix normally becomes soft. It starts to open (dilate) and thin (efface) to prepare for labor and delivery. If labor doesn't start on its own, it may be started artificially (induced).

Some doctors or midwives avoid the use of any medicine to induce a trial of labor. That's because they are concerned that the uterus may break open (rupture). Other doctors or midwives are comfortable with the careful use of oxytocin (Pitocin) to induce labor if the cervix is soft and dilating.

If your labor slows or stops progressing, your doctor or midwife may use oxytocin to strengthen your contractions.

Pain relief options

As with most vaginal births, you can safely use nonmedical and medical pain relief options during labor.

Nonmedical options include:

• Support. Having a doula or support person with you may help you manage your pain better.
• Breathing techniques. They can help distract you from pain.
• Imagery. For example, you could imagine your contractions as waves rolling over you.
• Changing positions. This can help you be more comfortable.
• Massage.
• Laboring in water.

Medical options include:

• Epidural anesthesia. This type partly or fully numbs the lower part of your body.
• Intravenous (I.V.) anesthesia. This type partly relieves pain and helps you relax.
• Nitrous oxide. You can give this to yourself by breathing it in through a mouthpiece or mask.
• A pudendal block. It numbs the vagina and perineum during the pushing part of labor.

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Recovery

Vaginal birth after cesarean (VBAC) recovery is similar to recovery after any vaginal birth. After a vaginal birth, you most likely can go home within 24 to 48 hours. Recovery from a C-section requires 2 to 4 days in the hospital. You'll also need a time of limited activity as the incision heals.

The overall risk of infection is low for both vaginal and cesarean deliveries. But it's lower after a vaginal birth. Before you leave the hospital, you will get a list of signs of infection to watch for in the first few weeks after the birth.

After the birth, it'll be important to take good care of yourself—by resting when you can, having good support, and staying healthy. Consider asking a loved one to stay with you to help for a few days. At first, plan to limit your guests and how long they stay, so you can rest.

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