For years, it was believed that the safest choice after giving birth via cesarean was another cesarean delivery. But now, guidelines have changed.

According to the American Congress of Obstetricians and Gynecologists (ACOG), a vaginal birth after cesarean, also known as VBAC, can be a safe and appropriate option. VBAC can work for many women who’ve had one, or even two, previous cesarean deliveries.

Your doctor can help you determine the best course of action for you and your baby. Here are the risks and benefits of VBAC.

What Are the Benefits of VBAC?

VBAC is a term used to describe the vaginal delivery a woman has after giving birth via cesarean. The Mayo Clinic notes that benefits of VBAC can include:

  • A faster recovery. If you deliver vaginally, you’ll spend less time in the hospital. This means fewer expenses. You can also expect to feel physically better sooner. 
  • A greater sense of involvement in the birth. Delivering vaginally may make you feel like a more active participant in the birth of your baby.
  • Less risk in subsequent pregnancies. Risks like infection, organ injury, and blood loss can increase with repeat elective cesarean deliveries. If you’re planning a large family, a VBAC may be a good option for you.

The National Institutes of Health (NIH) advise that a successful VBAC is actually the safest way for a woman who had a previous cesarean delivery to give birth. Success rates among women who attempt VBAC with a trial of labor are between 60 and 80 percent, with the remainder of babies being delivered surgically.

What Are the Risks of VBAC?       

The riskiest scenario is an emergency cesarean delivery after a failed VBAC. A VBAC may fail because of uterine rupture. This is where the uterus tears open along the scar line from a previous cesarean delivery.

In the event of uterine rupture, an emergency cesarean delivery would be necessary to avoid dangerous complications including heavy bleeding, infection to the mother, and brain damage to the baby.

A hysterectomy, or the removal of the uterus, may be needed as well. This means you would be unable to become pregnant again. Fortunately, ACOG notes that the risk of uterine rupture in women who had low transverse incisions during their cesarean delivery is low, approximately 1 in 500.

Am I a Candidate for VBAC?

Your chances of successfully delivering vaginally after one or two previous cesareans can be affected by a few factors, including the following.

  • Your baby is head down.
  • Your baby isn’t considered large. Babies weighing less than 7 pounds, 11 ounces have the best chance of VBAC success.
  • You’ve had a successful vaginal delivery before. A previous vaginal delivery can improve your chances of a successful VBAC by more than 90 percent.
  • Your reason for having a previous cesarean delivery isn’t an issue with this pregnancy.
  • You had a low transverse uterine incision, so you don’t have a vertical or T-shaped scar.
  • Your labor begins spontaneously. When you’re induced, contractions can be stronger and faster, increasing the odds of uterine rupture.

Your chances for a successful VBAC can decrease if you pass your due date, or you’ve had more than two cesarean deliveries.

In some cases, VBAC might not be safe for you. If you’ve experienced uterine rupture in a previous pregnancy, or you have a vertical incision from a prior cesarean delivery, VBAC isn’t recommended.

How Can I Prepare for a VBAC?

Learn everything you can about VBAC. Speak with your doctor about your chances of success based on your medical history and your current pregnancy. You should also consider researching and choosing a provider who is both supportive of VBACs and has a low cesarean delivery rate.

Look for a childbirth class covering VBAC, and make sure your partner is on board with the idea, too.

Choose your hospital carefully. During a VBAC, careful monitoring of you and your baby will be important to reduce the risk of complications. In the event of an emergency cesarean delivery, you’ll want to be at a facility that is well-equipped and capable of handling the surgery.

If possible, wait for labor to begin on its own. Remember that drugs used to induce labor can bring about stronger, faster contractions. This increases the risk of uterine rupture.

You don’t need to do anything special if you choose to deliver via VBAC. Your prenatal care will be the same as it would with any healthy pregnancy, and the delivery process will proceed normally. Expect to be closely monitored as you labor.

Remember, your health and the health of your baby is the ultimate goal, even if that means having a repeat cesarean delivery. Even if you have your heart set on delivering vaginally, be prepared for complications that could necessitate another surgery. Your labor could stall, your baby’s position could pose a risk, or there may be a problem with the placenta or umbilical cord.

Keep in mind: All that matters is a healthy mother and baby.

The Takeaway

If you’d like to learn more about your chances for a successful vaginal delivery after one or two cesarean deliveries, speak to your doctor. Together, you can review your previous pregnancies and the factors that prompted the decision to deliver surgically. Your doctor can help you evaluate your current pregnancy so that you can make the safest decision about VBAC or a repeat cesarean.