Vaginal birth after a Cesarean (VBAC)

If you have already had a Cesarean birth, you have two choices about how to give birth again:

• vaginal birth after Cesarean (VBAC)
• planned Cesarean delivery

A VBAC is when you have a vaginal birth after you have already had a Cesarean birth. This decision will be one that you and your health care provider will make together.

These are the guidelines for being able to have a VBAC, according to the ACOG:

• you have had one or two previous Cesareans
• you have not had previous uterine surgery
• your previous uterine scar has not ruptured
• the size of your pelvis is wide enough to attempt a vaginal birth and you have not had any pelvic problems
• you have no other restrictions

You should give birth in a hospital setting so the surgeon, nurses and an anesthesiologist are immediately available in case an emergency Cesarean birth is needed.

Reasons to consider a VBAC

For you:

• no major abdominal surgery
• a shorter hospital stay
• lower risk of infection
• lower need for a blood transfusion
• quicker recovery
• easier time breastfeeding

For your baby:

• easier to breathe (fluid is pushed out of the baby’s lungs when coming through the birth canal)
• more contact with you right after birth
• able to breastfeed right away
• easier to breastfeed

Risks of a VBAC

You and your health care provider should review the benefits and risks of a VBAC and consider what is best for you. Your provider will fully talk about the risks with you.

There is no guarantee a VBAC will work, which can result in a Cesarean birth.

There is an increased risk of uterine rupture, which is a tear or opening in the uterus. This happens in fewer than 1 out of 100 VBACs. This can be a life-threatening emergency.

Pain control

You have options to control pain during vaginal birth. The most common option is a labor epidural.

Your health care provider will insert a small catheter (thin plastic tube) into your lower back. The tip of the catheter rests in the area just outside the spinal cord. This area is called the epidural space. Medicines to control labor pain are given through the catheter.

Your health care provider will explain the benefits and risks of a labor epidural. They can explain other pain control options that are available.

Your feelings

You may have mixed or negative feelings about giving birth vaginally.

You may be afraid to attempt labor, not knowing what to expect. You may favor a Cesarean because you know what to expect. If your last birth started with labor and ended with a Cesarean, you may not want to go through labor again.

Remember, each pregnancy and labor is different. In deciding if a VBAC is right for you, your health care provider will take your specific health into account.