Vaginal birth after cesarean

KEY POINTS

  • If you’ve already had a cesarean birth (also called c-section), you may be able to have your next baby vaginally. This is called vaginal birth after cesarean (also called VBAC).

  • You may be able to have a VBAC if your pregnancy is healthy and the incision (cut) in your last c-section was low transverse.

  • VBAC isn’t safe for all women. Talk to your provider to make sure it’s right for you and your baby.

  • If you are able to have a VBAC, there are some benefits like needing less time to recover and not needing surgery. 

  • Not all providers, hospitals and birthing centers offer VBAC. Talk to your provider to see if VBAC is available where you’re planning to have your baby.

If you’ve already had a cesarean birth (also called c-section), you may be able to have your next baby vaginally. This is called a vaginal birth after cesarean (also called VBAC). Cesarean birth is surgery in which your baby is born through a cut that your health care provider makes in your belly and uterus. 

More than 6 to 8 out of 10 women (more than 60-80 percent) who try VBAC are successful in having their baby vaginally. Talk to your health care provider early in your pregnancy to find out if VBAC may be a good choice for you and your baby.

How do you know if having a VBAC is right for you?

Talk to your provider if you’re thinking about having a VBAC. Your provider can help you look at the risks and benefits. If your risks are low and your chances of having a successful VBAC are high, then you may decide that VBAC is right for you.

Your chances of having a successful VBAC are better if:

  • You’ve had a vaginal birth before. 
  • You’ve had just one c-section in the past with a low transverse incision (also called a bikini cut).
  • This means the cut was horizontal (side-to-side) and low on the uterus. This is the most common kind of c-section incision. It usually bleeds less than other incisions. It also makes a stronger scar on the uterus, which makes it less likely to tear. 
  • You and your baby are in good health during pregnancy. 
  • Your labor starts on its own just before or on your due date.

Your chances of having a successful VBAC are worse if:

  • You have the same condition in this pregnancy that made your c-section necessary in a past pregnancy. For example, your baby has problems with his heart rate or is lying sideways in the womb. 
  • You’re past your due date or your labor is induced.  
  • You’re obese or you gained excessive weight during pregnancy. If you're obese, you have an excess amount of body fat and your body mass index (also called BMI) is 30 or higher. To find out your BMI, go to www.cdc.gov/bmi.
  • You have preeclampsia. This is a condition that can happen after the 20th week of pregnancy or right after pregnancy. It’s when a pregnant woman has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working properly. Signs of preeclampsia include having protein in the urine, changes in vision and severe headache.
  • There’s less than 18 months between your last pregnancy and your current pregnancy (called a short interpregnancy interval).
  • Your baby is very large. 
  • Your provider, hospital or birthing center isn’t prepared to handle an emergency c-section if you need one. Talk to your provider about the level of medical care that’s available in the hospital or birthing center where you plan to have your baby.  
  • You’re older than 35 or a race other than white. 
  • Some providers may not offer VBAC if you’ve had more than two past C-sections or if you are pregnant with triplets or a higher number of multiples 

It’s not safe to have a VBAC if:

  • You had a c-section in the past and your incision was not low transverse and instead was high vertical.  A high vertical incision cuts up and down through muscles in the upper part of the uterus that strongly contract during labor.  This can lead to a uterine rupture (tear in the uterine muscle).
  • You had a uterine rupture in a previous pregnancy. This is when the uterus (womb) tears during labor. It happens very rarely.
  • You’ve had certain types of surgery on your uterus. 
  • You have certain health conditions or complications during pregnancy, like diabetes, heart disease, genital herpes or placenta previa, that make a c-section necessary.

What are the benefits of having a VBAC?

Having a VBAC has some benefits, including:

  • There’s no need for surgery.
  • Your recovery time is shorter than after having a c-section.
  • There’s less blood loss.
  • Your risk is lower for infection and other complications, like problems with the placenta called placenta previa and placent acreta.
  • If you’re planning to have a lot of children, there’s less risk of complications from repeated surgeries, including scarring or injuries to the bowel or bladder. 
  • You may want to have the experience of a vaginal delivery. 

What are the risks of having a VBAC? 

VBAC can have some risks, even if both you and your baby are healthy during pregnancy. These risks include:

  • Your labor doesn’t go well and you need a c-section anyway. 
  • Infection, injury and blood loss
  • Your uterus ruptures (tears).  This is rare, but it can be life-threatening.

How do I prepare for a VBAC?

  • If you previously had a C-section and you’re pregnant, talk to your provider about VBAC at your first prenatal visit.
  • You may be able to take a childbirth class on VBAC.
  • Be flexible and know that sometimes complications can happen that require needing a C-section.  Ask your provider if your hospital of delivery has what it needs in case of an emergency C-section.  A home delivery is not appropriate for VBAC.  VBAC should take place in a hospital.

See also: Medical reasons for a c-section, Inducing laborStages of labor

Last reviewed March 2020