If you’ve had a C-section before, you may wonder what your options are for your next delivery. Many women are able to choose between scheduling a repeat C-section and attempting a vaginal birth after cesarean, or VBAC. In fact, about 60-80% of women who attempt a vaginal delivery will be successful. Planning for either type of delivery requires a careful discussion with your doctor or midwife, and there are a few things to consider.
1. Am I a candidate?
Many women are candidates for VBAC. There are factors that increase or decrease your chance of successful vaginal delivery, and you are better candidate if you have a high chance of success. A VBAC is NOT recommended if you’ve had a vertical (or classical) incision on your uterus or if you’ve ever had a uterine rupture in the past. Your provider can help you determine if you are a candidate.
2. How likely am I to be able to deliver vaginally?
Your chance of successful VBAC are higher if:
- You’ve had a vaginal delivery in the past
- You go into labor on your own
- You are healthy and of normal weight/BMI
- Your previous C-section was done for a reason that isn’t present this time (breech presentation, problems with baby’s heart rate)
Your chance of successful VBAC are lower if:
- Your pregnancy goes past your due date
- You have a very large baby
- Your previous C-section was done for reasons that may recur (failure to dilate or failure of baby to descend in the birth canal)
3. What are the benefits?
An uncomplicated VBAC has lower risk compared to C-section. Advantages include:
- Shorter hospital stay and recovery time
- Less pain after delivery
- Lower risk of infection
- Lower risk of blood clots
- Lower risk of blood transfusion
- Ability to have vaginal deliveries rather than C-section in future pregnancies
4. What are the risks?
As with any delivery, we don’t know ahead of time if a VBAC will work. A VBAC that is NOT successful is generally more risky than a scheduled C-section. Risks include:
- Need for C-section in labor
- Uterine rupture (the previous C-section scar opens during labor). This is the most serious complication, and this happens in about 1% of cases. If uterine rupture occurs, it can lead to emergency C-section, heavy bleeding, need for hysterectomy (removal of the uterus) or brain damage for the baby.
5. What should I expect in labor?
Women who are planning a VBAC usually follow the same process as any other labor, though your baby will be monitored more closely. It is important to be in the hospital for continuous monitoring during labor to make sure you and baby are safe.
Having a VBAC can be safe and successful, but it is important to discuss your questions and risks with your provider to ensure that you can make the decision that’s best for you.
Written By: Dr. Leigh Koidahl, MD