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Is it possible to choose a vaginal birth after cesarean section?

April 30, 2014

Did you know that each year, a little over one third of all pregnant women in the US deliver by cesarean section (c-section)? For women who choose to have more than one child, this often leads them to wonder if it’s possible to deliver vaginally after delivering via c-section. Here, I’ll outline the most important pros, cons, and risks you may need to consider before choosing to attempt a vaginal birth after cesarean, also known as “VBAC.”

Is a VBAC safe?

For much of the past 100 years, the predominant medical opinion has been “once a cesarean, always a cesarean."  But not so fast. These days there is broad, research-backed consensus that VBACs are a safe, reasonable option for women. Women considering this option must, however, meet certain criteria and only attempt the VBAC in the right healthcare setting. That said, you should know that not all healthcare professionals feel comfortable attempting a VBAC, and that not all hospitals meet the necessary requirements to safely accommodate a VBAC. If you think you might be interested in attempting a VBAC, you should contact your healthcare provider early on to make sure your healthcare team can support your decision.

What’s the difference between a TOLAC and VBAC?

Although they have different meanings, TOLAC and VBAC are two terms you might hear used somewhat interchangeably. A trial of labor after cesarean, or a TOLAC, occurs when a woman attempts to deliver vaginally after a cesarean. On the other hand, vaginal birth after cesarean, or VBAC, refers to a successful attempt to deliver vaginally. Roughly 60 to 80% of women who attempt a TOLAC are able to successfully deliver vaginally.

What are the Benefits of a VBAC?

There are many reasons why a VBAC is an attractive option for pregnant women. Generally, women who deliver vaginally have less pain after delivery, spend fewer days in the hospital, and have a lower risk for infection and postpartum complications. They also avoid further scarring of the uterus. This is particularly important for women who are planning to have future pregnancies. The more scars a woman has on her uterus, the greater her risk for problems during pregnancy and delivery. Also, depending on the circumstances of a woman’s previous c-section, there may be important emotional reasons for wanting to attempt a VBAC. For instance, if a woman experienced complications during a previous pregnancy and had to deliver via c-section, she may feel that delivering vaginally will give her a chance to take a more active role in the birthing process.

What are the Risks Associated With a VBAC?

Although very rare, the most serious risk associated with a VBAC is a uterine rupture. A uterine rupture occurs when a c-section scar opens during labor. Should this happen, the baby and placenta move into the abdomen creating an extremely serious risk for both the baby and the mother. This risk is the primary reason why a VBAC should only be attempted in a hospital where, if needed, the baby could be delivered by rapid emergency c-section at any time.

Am I a good candidate for a VBAC?

Of course, only your healthcare provider can determine whether or not you’re a good candidate for a VBAC. Generally speaking however, a woman is a good candidate for a VBAC if she meets the following criteria:
  • The woman has no major medical problems and is in good health
  • The woman has had just one previous c-section
  • The c-section was a low-transverse uterine incision (horizontal incision), with no complications
  • The baby is healthy and positioned head down
  • The reason for the previous c-section is not present in her current pregnancy.
On the other hand, a women should not consider a VBAC if she has had:
  • Two or more previous c-sections
  • A previous c-section incision that was not a low-transverse uterine incision, for example, a T-shaped or vertical incision
  • A previous uterine rupture
  • Previous removal of fibroids from the uterus
Other health issues such as a very high body mass index (BMI) or high blood pressure may prevent a woman from attempting a VBAC as well.

The great news is that a VBAC is a safe and realistic option for most women. If you think you may want to seek a VBAC, I encourage you reach out to your healthcare provider to start discussing your options.

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