Pregnancy: Should I Try Vaginal Birth After a Past C-Section (VBAC)?

Pregnancy: Should I Try Vaginal Birth After a Past C-Section (VBAC)?

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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

Your options

  • 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.
FAQs

What is a 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.

Is VBAC a good choice for you?

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 or two C-sections, 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.

What are the benefits of VBAC?

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.

What are the risks of VBAC?

Risks of VBAC
include:

  • Problems during labor that result in a cesarean delivery. This occurs with about 25 out of 100 women who try VBAC. But
    it doesn't happen with about 75 out of 100 women who try VBAC.footnote 1

  • Rupture of the scar on the uterus
    , which is rare
    but can be deadly to the mother and baby. About 5 out of 1000 women have a uterine rupture during a trial of labor.footnote 1 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.footnote 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.

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.
  • 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.

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.

Why might your doctor recommend a C-section instead of VBAC?

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

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 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.
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 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.

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 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.

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

What else do you need to make your decision?

Check the facts

1, Is it likely that you can give birth vaginally after having had a cesarean before?
2, If you try VBAC, might you still need to have a C-section?
3, Do all hospitals and doctors offer VBAC?

Decide what's next

1,Do you understand the options available to you?
2,Are you clear about which benefits and side effects matter most to you?
3,Do you have enough support and advice from others to make a choice?

Certainty

1.
How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure


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

Credits and References

Credits
Author Healthwise Staff
Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Kirtly Jones, MD - Obstetrics and Gynecology

References
Citations
  1. Guise JM, et al. (2010). Vaginal birth after cesarean: New insights. Evidence Report (Publication No. 10-E003). Rockville, MD: Agency for Healthcare Research and Quality. https://www.ncbi.nlm.nih.gov/books/NBK44571/pdf/Bookshelf_NBK44571.pdf. Accessed June 12, 2018.
  2. American College of Obstetricians and Gynecologists (2017). Vaginal
    birth after cesarean delivery. ACOG Practice Bulletin No. 184. Obstetrics and Gynecology, 130(5): e217–e233. DOI:
    10.1097/AOG.0000000000002398. Accessed May 25, 2018.
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)?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • 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.
FAQs

What is a 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.

Is VBAC a good choice for you?

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 or two C-sections, 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.

What are the benefits of VBAC?

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.

What are the risks of VBAC?

Risks of VBAC
include:

  • Problems during labor that result in a cesarean delivery. This occurs with about 25 out of 100 women who try VBAC. But
    it doesn't happen with about 75 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. About 5 out of 1000 women have a uterine rupture during a trial of labor.1 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.

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.
  • 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.

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.

Why might your doctor recommend a C-section instead of VBAC?

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.

2. Compare your 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 you have
    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

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. 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 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.

             
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. 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

5. What else do you need to make your decision?

Check the facts

1.
Is it likely that you can give birth vaginally after having had a cesarean before?

  • Yes
  • No

  • I'm not sure

You'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.

2.
If you try VBAC, might you still need to have a C-section?

  • Yes
  • No

  • I'm not sure

That'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.

3.
Do all hospitals and doctors offer VBAC?

  • Yes

  • No
  • I'm not sure

You're right. Some hospitals and doctors don't offer VBAC.

Decide what's next

1.
Do you understand the options available to you?

2.
Are you clear about which benefits and side effects matter most to you?

3.
Do you have enough support and advice from others to make a choice?

Certainty

1.
How sure do you feel right now about your decision?

         
Not sure at all
Somewhat sure
Very sure

2.
Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

 

Credits
By Healthwise Staff
Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Kirtly Jones, MD - Obstetrics and Gynecology

References
Citations
  1. Guise JM, et al. (2010). Vaginal birth after cesarean: New insights. Evidence Report (Publication No. 10-E003). Rockville, MD: Agency for Healthcare Research and Quality. https://www.ncbi.nlm.nih.gov/books/NBK44571/pdf/Bookshelf_NBK44571.pdf. Accessed June 12, 2018.
  2. American College of Obstetricians and Gynecologists (2017). Vaginal
    birth after cesarean delivery. ACOG Practice Bulletin No. 184. Obstetrics and Gynecology, 130(5): e217–e233. DOI:
    10.1097/AOG.0000000000002398. Accessed May 25, 2018.

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