Vaginal birth after cesarean

Cesarean birth (c-section) is surgery in which your baby is born through a cut that your health care provider makes in your belly and uterus. It used to be that once you had a baby by c-section, all of your future babies would have to be born by c-section, too.

Health experts now believe that a vaginal birth after a c-section (called VBAC) can be safe for many women and their babies, even though there may be some risks. Talk to your health care provider to find out if VBAC may be a good choice for you and your baby.

What are some benefits of having VBAC?
About 6 to 8 out of 10 women (60 to 80 percent) who try a VBAC are successful in having a vaginal birth. Even women who’ve had more than one c-section in the past may be able to have a VBAC safely. Some of the benefits of having a VBAC include:

  • No need for surgery
  • Shorter recovery time than after a c-section
  • Lower risk of infection, blood loss or other c-section health complications

Is VBAC a good choice for you?
VBAC is a good choice for many women, but not all. You may be able to have a VBAC if:

  • You had at least one vaginal birth before or after your last c-section.
  • You had a past c-section for a reason that isn’t a problem in this pregnancy. For example, you had an infection in your last pregnancy, but not in this pregnancy.
  • Your past c-section incision (cut) was side-to-side in the lower part of your uterus (womb). This is called a low transverse incision.
  • You and your baby are in good health during pregnancy.
  • Your labor starts on its own, before or on the day that your baby’s due.

Talk to your provider if you think VBAC may be right for you.

Are there any risks?
Even when both mom and baby are healthy during pregnancy, VBAC can have some risks. VBAC risks include:

  • Your labor doesn’t go well and you have to have a c-section anyway.
  • Your baby has a hard time handling the stress of labor.
  • If you have an emergency (unplanned) c-section after labor starts, you’re at increased risk of getting an infection in your uterus.
  • Although rare, the uterus may tear or even rupture during labor where your past c-section incision was made. This can be life-threatening. To make uterine tear or rupture less likely, your health care provider needs to take a careful history of what kind of incision you had in your past c-section and monitor your labor carefully.

Are all c-section incisions safe for VBAC?
No. Knowing whether or not you can safely have a VBAC depends not only on your and your baby’s health, but also on the kind of c-section incision you had in your past pregnancy.

A low transverse incision is the most common kind of c-section incision. It’s made side-to-side in the lower part of your uterus, where the wall of your uterus is thinnest. This incision usually bleeds less than other incisions. It also makes stronger scars, making it less likely that the scar on the uterus will rupture. If you had a low transverse incision in your c-section, you may be able to have a VBAC.

Other types of c-section incisions aren’t safe for VBAC. Talk to your provider about the kind of incision you had to see if VBAC is a safe option for you.

Who should not have a VBAC?
Some health conditions lower your chance of having a safe VBAC. A VBAC may not be a safe choice for you if:

  • You had any c-section incision other than a low transverse incision.
  • There are problems with the placenta, the organ that grows in your uterus and supplies the baby with food and oxygen through the umbilical cord.
  • You have certain health conditions during pregnancy, like diabetes, high blood pressure, heart disease or genital herpes.
  • You’re carrying multiples (twins, triplets or more).
  • Your labor is induced. This is when your provider gives you medicine or breaks your water (amniotic sac) to make you start labor.
  • You had two or more c-sections and never had a vaginal birth.
  • You’re older than 40.
  • You’re past your due date.
  • You have an unusually large baby.

Do all providers and hospitals offer VBAC?
The American College of Obstetricians and Gynecologists (ACOG) says that providers should offer VBAC to all women with healthy pregnancies who are good candidates for VBAC and who don’t have any of the complications listed above.

But ACOG also says that providers should do VBACs only in hospitals and facilities that have certain emergency care services. These services may not be available everywhere, so some providers and hospitals may not offer VBAC.

Remember that most (about 7 in 10) VBACs are successful. If you want to have a VBAC, talk to your provider. If she can’t provide a VBAC, you may need to look for other care options near you.

August 2011

See also: C-section: Medical reasons, Inducing labor, Stages of labor

Most common questions

What is an epidural?

An epidural is the most popular and effective kind of pain relief for labor. You get a needle with a small tube attached placed in your lower back. Medicine goes through the tube while you're in labor. It numbs your lower body so you can't feel the pain from your contractions. The medicine doesn't make you go to sleep, so you can be wide awake when your baby is born!

What is fetal-scalp blood sampling?

Fetal-scalp blood sampling is a quick test your health care provider can use to check if your baby is getting enough oxygen during labor.

During labor, your cervix dilates (opens) to let your baby out. Your cervix is the opening to the uterus that sits at the top of the vagina. In order to have fetal-scalp blood sampling, your cervix must be dilated enough that your provider can reach your baby’s head.

The test may remind you of a pelvic exam. It takes about 5 minutes. You lie on your back with your feet in stirrups. Your provider places a plastic cone in the vagina that fits up against the baby’s head. Your provider pricks your baby’s scalp and takes a small amount of blood. The blood is tested, and results are ready in a few minutes.

You may feel some pressure during the test, but it shouldn’t hurt. Your baby may have some bruising or bleeding at the spot where he’s pricked.

If you have an infection, like HIV or hepatitis C, your provider may not recommend fetal blood sampling. This is because you can pass these infections to your baby through the spot where he’s pricked.

What is oxytocin?

Oxytocin is a hormone your body makes to help start labor contractions. Contractions are when the muscles of your uterus get tight and then relax. They help push your baby out of your uterus (womb).

Your body also makes oxytocin during breastfeeding. Oxytocin helps your uterus shrink back to its original size after giving birth.

If labor is slow to start or your contractions stall, your health care provider may give you a medicine called Pitocin. Pitocin acts like oxytocin and can help start contractions or make them stronger.

What is Pitocin?

Pitocin is a medicine that acts like oxytocin, a hormone your body makes to help start labor contractions. Contractions are when the muscles of your uterus get tight and then relax. They help push your baby out of your uterus (womb). Health care providers often use Pitocin to:

  • Help induce labor
  • Help labor move along if your contractions slow down, or if they aren’t strong enough

You may start having labor contractions shortly after you get Pitocin. It can make your contractions very strong and lower your baby's heart rate. Your provider carefully monitors your baby's heart rate for changes and adjusts the amount of Pitocin you get, if needed.

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