Vaginal Birth After Cesarean (VBAC)

What is vaginal birth after cesarean (VBAC)?

Vaginal birth after cesarean (VBAC) means giving birth through your vagina after giving birth previously by cesarean section (C-section). A C-section involves making a surgical cut (incision) through your belly, then through your uterus. Your baby is delivered through the incision.

Is it safe to have a vaginal birth after cesarean (VBAC)?

Because a surgical cut results in a scar on your uterus, concern had been raised that the pressure of labor could cause your uterus to open (rupture) along the scar. However, according to the American Pregnancy Association, published studies show that 60% to 80% of women who had a cesarean birth have had a successful vaginal birth in their next pregnancy. This statistic is supported by another from the National Institute of Child Health and Human Development that showed that about 75% of VBAC attempts are successful.

What’s the risk of a uterine rupture if you’ve had a previous C-section?

According to the American College of Obstetricians and Gynecologists, the risk of a ruptured uterus if you’ve had previous C-section with a horizontal (transverse) cut is about 0.9% or slightly less than 1 in 100.

What health problems may happen if my uterus ruptures?

If your uterus were to rupture, risks include:

• Blood loss.
• Hysterectomy.
• Blood clots.
• Bladder damage.
• Infection.

Does the incision type made during a C-section make a difference in the risk of a future uterine rupture?

The answer may not be scientifically confirmed, but there is some thought that:

• A low transverse incision is associated with the lowest risk of uterine rupture. This horizontal cut is made across the lower, thinner part of your uterus.
• A low vertical incision is associated with a higher risk of rupture than a low transverse incision. This vertical cut is made in the lower, thinner part of the uterus.
• Ahigh vertical incision in the upper part of the uterus is associated with the highest risk. This type of incision is sometimes made to deliver preterm babies.

Please understand that the location and direction of the outer incision in your abdomen doesn’t mean that the incision in your uterus was made in the same location or in the same direction. The information about the location and direction of the incision on your uterus should be in the medical record of your C-section(s). When you discuss the appropriateness and safety of VBAC, make sure you or your healthcare provider review your medical record and the reasons why you had a C-section.

Generally, can I have a vaginal birth after a cesarean delivery?

You should talk with your healthcare provider about your unique health history, current pregnancy circumstance and the reason why you had a C-section previously.

You increase your chance of VBAC if you:

• Have had no more than two previous C-section deliveries with low transverse incisions.
• Have no other uterine scars or abnormalities.
• Have no previous uterine ruptures.

If you’ve already had a successful VBAC — without complications such as ruptured uterus — you’re more likely to have successful future vaginal deliveries.

What are the risks of a C-section?

General risks of C-section include:

• Risks from anesthesia.
• Blood loss from surgery.
• Infection in the uterus, bladder or skin incision.
• Injury to bladder, bowel and other nearby organs.
• Longer recovery period.
• Pain and discomfort around the incision.
• Blood clots in your pelvis or legs.
• Increased risk of uterine rupture, hysterectomy and surgical complications with each C-section.
• Increased risk of abnormal attachment of the placenta in future pregnancies due to scar tissue. The placenta provides oxygen and nutrients to your baby and removes carbon dioxide and waste products.

What are the risks/complications of vaginal delivery?

Complications of labor in general include:

• Labor that doesn’t progress after contractions start.
• Tears in the vagina and surrounding tissues that happen during delivery (called perineal tears).
• Baby doesn’t get enough oxygen (perinatal asphyxia).
• Baby’s shoulder gets stuck in the vagina (shoulder dystocia).
• Umbilical cord problems, including becoming compressed, wrapped around limbs or neck or comes out before the baby.
• Excessive bleeding from placenta that remains behind in the uterus.

What are the benefits of vaginal birth after cesarean (VBAC)?

The benefits of VBAC compared with C-section include:

• Faster recovery.
• No abdominal surgery.
• Less blood loss.
• Vaginal birth helps clear your baby’s lungs as your baby passes through the birth canal. This better prepares your baby to breathe oxygen after birth.
• Immune system boost babies may receive from the good bacteria they pick up in their travel through the birth canal.
• Avoiding or lowering the risk factors associated with a C-section.

What questions should I ask my healthcare provider about vaginal birth after cesarean (VBAC) and repeat C-section?

Both vaginal birth after cesarean (VBAC) and C-sections have risks and benefits. Many have been discussed in this article. Be sure to ask if there are any risks or benefits that could affect your pregnancy.

Topics to discuss include:

• Previous pregnancies and deliveries.
• Reason why you had a C-section.
• Safety of VBAC and a repeat C-section for you and for your baby.
• Reasons why you should or shouldn’t consider VBAC.
• Reasons why you should or shouldn’t consider repeat C-section.
• Plan for inducing labor (or not).
• Ability of the delivery facility to manage emergency delivery complications.
• Your plan for more children.

A note from Cleveland Clinic

Don’t assume that because a previous child was born via C-section that all of your future children need to be delivered this way. You may have read or been told that the scars from a C-section incision may rupture in a future pregnancy. The likelihood of the uterus scar splitting open is low.

Discuss VBAC and C-section options with your healthcare provider early in your pregnancy. Make sure you understand your risks and that your provider understands your preferences. As your pregnancy progresses, make sure you and your provider discuss and reevaluate your delivery plan at each late-term visit.