Should I Be Concerned About the Risks of VBAC?

Medically reviewed by Janine Kelbach, RNC-OB on February 4, 2016Written by Rachel Nall, RN, BSN, CCRN on February 4, 2016
VBAC: What Are the Risks

VBAC is the short term for vaginal birth after cesarean. Doctors pronounce it “VEE-back.”

If you’re expecting a baby and have had a cesarean delivery in the past, you might be able to have a vaginal birth this time around.

There are some risks involved with VBAC, so it’s important to consider this decision carefully. Of course, some mothers may plan and attempt a VBAC. But if their babies appear to be in any distress, they will need to change to a cesarean delivery.

What Is a Trial of Labor After Cesarean Delivery (TOLAC)?

Anywhere from 60 to 80 percent of women who attempt VBAC are able to successfully deliver their babies vaginally.

When discussing delivery with your doctor, you’ll likely discuss the following factors.

  • History of vaginal deliveries. If you’ve successfully delivered vaginally, either before or after your last cesarean, chances are you can successfully deliver another baby this way again.
  • Cesarean incision type. If you had a vertical incision in the upper portion of your uterus (a classical incision), your risk for uterine rupture is higher. In this case, your doctor will likely recommend scheduling a repeat cesarean delivery. If you had a low transverse (side-to-side) incision, it may be safe to attempt a vaginal delivery.
  • The reason for your last cesarean. For some women, cesarean delivery is necessary because of the position of their baby. For example, some babies are face up or breech (feet first). These aren’t considered good positions for labor.
  • Medical history. If your doctor recommended a cesarean in the past because of your medical history, you may need another one. Examples of health concerns include placenta problems, genital herpes, or HIV. If you’ve had a history of uterine rupture, attempting to deliver vaginally will be too risky.

It’s important to note that a cesarean delivery after a mom has already tried labor is associated with more potential complications. Your doctor will take these factors into account, as well as your desire for a TOLAC.

Benefits of VBAC

While there are risks associated with TOLAC, there are also benefits to you. Some reasons why you may wish to attempt a delivery include:

  • shorter recovery times and hospital stay (typically)
  • reduced infection risk
  • reduced risk for placenta problems
  • less blood loss
  • no abdominal surgery required

There are also risks associated with having multiple cesareans, including hysterectomy and bladder/bowel injuries.

Your baby is also less likely to have breathing problems after birth because they will get the “squeeze” from moving through the birth canal. This helps to expel fluid from your baby’s lungs.

No birth is without risk, but a cesarean delivery is a major surgery. Recovery times are longer than a vaginal birth. Your doctor can help you evaluate these risks and create a birth plan that will help you deliver your baby safely.

Possible Complications from VBAC

When you have a cesarean delivery, a doctor will make an incision in your uterus to access your baby. While this incision will heal with time, a scar still remains to the uterus. As a result, the uterus is more vulnerable to rupture during a subsequent delivery.

A uterine rupture occurs in 1 out of every 200 VBAC-attempted deliveries. This is about 0.5 percent of all births. If the uterus ruptures during delivery, it can be a life-threatening and serious medical emergency for mom and baby.

A uterine rupture causes severe bleeding that can cause a woman to require an emergency cesarean, blood transfusion, and possibly a hysterectomy. After the uterine rupture, a new mom is at high risk for infection and is often given antibiotics.

Some women prefer the convenience of scheduling a cesarean delivery when their babies have matured enough in the womb. Others might see the benefits of not experiencing labor pains.

The Takeaway

If you do choose to attempt a VBAC, you’ll have to deliver your baby in a hospital. Home births are too risky after you’ve had a cesarean delivery. But having a history of cesarean doesn’t mean you can’t have certain types of anesthesia, like an epidural. This can help reduce pain associated with delivery.

You can talk to your doctor about how you wish to deliver your baby. They will help you determine the risks and benefits. If your doctor suggests a trial of labor, keep in mind, there’s always the chance you could require a cesarean again.

The good news is that either way, you’ll welcome your precious little one safely into the world. 

Rachel Nall
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