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Vaginal Birth After Cesarean (VBAC)
What is a vaginal birth after cesarean (VBAC)?
If you have had a cesarean delivery (also called a C-section) before, you may be able to deliver your next baby vaginally. This is called vaginal birth after cesarean, or VBAC.
If you and your doctor agree to try a VBAC, you will have what is called a "trial of labor." This means that you plan to go into labor with the goal to deliver vaginally. But as in any labor, it is hard to know if a VBAC will work. You still may need a C-section. As many as 4 out of 10 women who have a trial of labor need to have a C-section. 1
Is a VBAC trial of labor safe to try?
Having a vaginal birth after having a C-section can be a safe choice for most women. Whether it is right for you depends on several things, including why you had a C-section before and how many C-sections you've had. You and your doctor can talk about your risk for having problems during a VBAC trial of labor.
A woman who chooses VBAC is closely monitored. As with any labor, if the mother or baby shows signs of distress, an emergency cesarean section is done.
What are the benefits of a VBAC?
The benefits of a VBAC compared to a C-section include:
What are the risks of VBAC?
The most serious risk of a VBAC is that a C-section scar could come open during labor. This is very rare. But when it does happen, it can be very serious for both the mother and the baby. The risk that a scar will tear open is very low during VBAC when you have just one low cesarean scar and your labor is not started with medicine. This risk is why VBAC is often only offered by hospitals that can do a rapid emergency C-section.
If you have a trial of labor and need to have a C-section, your risk of infection is slightly higher than if you just had a C-section.
Frequently Asked Questions
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Is VBAC Right 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 VBAC is right for you depends on what risk factors (things that increase your risk) you have that could make it unsafe. You and your doctor can decide whether VBAC is right for you.
As with a first-time childbirth, even if you are a good candidate for a successful VBAC, there is no guarantee that you will give birth vaginally and without complications.
What Affects VBAC Success
Pregnancy, labor, and delivery are different for every woman and difficult to predict. Even if your first pregnancy required a cesarean, the next one may not. The likelihood of a successful vaginal birth after cesarean (VBAC) is influenced by various factors. Usually a combination of factors affects how well or poorly a trial of labor goes.
Your chances of a successful VBAC are best when: 1
Your chances of a successful VBAC are lower when: 1
Risks of VBAC and Cesarean Deliveries
Whether you deliver vaginally or by cesarean section, you are unlikely to have serious complications. Overall, a routine vaginal delivery is less risky than a routine cesarean, which is a major surgery. But a pregnant woman who has a cesarean scar on the uterus has a slight risk of the scar breaking open during labor. This is called uterine rupture.
Although rare, uterine rupture can be life-threatening for both mother and baby. So women with risk factors for uterine rupture should not attempt a vaginal birth after cesarean (VBAC).
Risks of VBAC
The risks of VBAC include:
Risks of any cesarean
The risks of cesarean delivery include:
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. 4
For more information about cesarean risks, see the topic Cesarean Section.
Exams and Tests
Besides the usual prenatal tests, your doctor will take measures to assess whether vaginal delivery is likely to be a safe birthing option for you. (For more information on standard prenatal tests, see the topic Pregnancy.) These extra measures can help you and your doctor make a well-informed decision about your delivery.
Assessments done sometime during the pregnancy to help find out whether vaginal birth after cesarean (VBAC) is a safe option may include:
What to Expect
Information, preparation, and teamwork are needed for a successful vaginal birth after cesarean (VBAC).
Childbirth and VBAC education
To prepare for labor, consider taking a childbirth education class at your local hospital or clinic. You and your birthing partner can learn:
Other than requiring closer monitoring, labor for a VBAC is the same as normal labor. During early labor, a woman can remain as active and mobile as she wants. There are no specific restrictions for VBAC until active labor begins. During the active period of labor, continuous fetal heart monitoring is done to watch for early signs of fetal distress or uterine rupture. (For more information, see Exams and Tests.)
For more information about labor and delivery, see the topic Labor, Delivery, and Postpartum Period.
Medicines for starting or strengthening VBAC labor
As the end of pregnancy nears, the cervix normally becomes soft and begins to open (dilate) and thin (efface), preparing for labor and delivery. When labor does not naturally start on its own, labor may be started artificially (induced).
Some doctors avoid the use of any medicine to start (induce) a VBAC trial of labor, because they are concerned about uterine rupture. Other doctors are comfortable with the careful use of oxytocin (Pitocin) to start labor when the cervix is soft and opening (dilating).
If your labor slows or stops progressing, your doctor may use oxytocin to strengthen (augment) contractions.
As with most vaginal births, most women who choose VBAC can safely use pain medicine during labor.
Pain medicine usually is started when the cervix has opened (dilated) 3 cm (1.2 in.) to 4 cm (1.6 in.). Types of pain medicines used include:
Vaginal birth after cesarean (VBAC) recovery is similar to recovery after any vaginal birth. After a vaginal delivery, the mother and baby can usually go home within 24 to 48 hours. By comparison, recovery from a cesarean section requires 2 to 4 days in the hospital and a period of limited activity as the incision heals.
The overall risk of infection is low for both vaginal and cesarean deliveries. But it is lower after a vaginal birth. Before you leave the hospital, you will receive a list of signs of infection to watch for in the first few weeks after delivery.
For more information, see:
What to Think About
Any woman in labor—not just one attempting a vaginal birth after cesarean (VBAC)—might have complications during childbirth that require a cesarean section delivery.
If there is no medical reason for a cesarean, vaginal delivery is generally a safe option for both mother and baby. It is common, though, to fear going through labor after having had a cesarean delivery. This is especially true for women who have tried a vaginal birth but, after a long and difficult labor, ended up delivering by cesarean.
The ultimate decision to try a vaginal birth is made by you and your doctor. If you want to try a VBAC but your doctor is not in favor of your choice and does not have a clear reason, consider getting a second opinion.
If you are considering VBAC, talk with your doctor about:
Other Places To Get Help
Last Revised: March 28, 2011
Author: Healthwise Staff
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.
Bujold E, et al. (2004). Trial of labor in patients with a previous cesarean section: Does maternal age influence the outcome? American Journal of Obstetrics and Gynecology, 190(4): 1113–1118.
Cunningham FG, et al. (2010). Prior cesarean delivery. In Williams Obstetrics, 23rd ed., pp. 565–576. New York: McGraw-Hill.
Paré E, et al. (2005). Vaginal birth after caesarean section versus elective repeat caesarean section: Assessment of maternal downstream health outcomes. British Journal of Obstetrics and Gynaecology, 113(1): 75–85.
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