If you have delivered a baby by C-section and you are pregnant again, you may be able to choose between another C-section or a vaginal birth after cesarean (VBAC).
VBAC may be attempted if the previous C-section was performed more than 18 months before the current pregnancy. However, there are risks associated with VBAC, especially if there is uterine scarring, a history of uterine rupture, or complicated delivery during the previous cesarean delivery.
Risks associated with VBAC delivery include:
- Uterine rupture
- This is a life-threatening complication for both mother and baby. If a uterine rupture occurs, a hysterectomy (surgical removal of the uterus) may be required. Following a hysterectomy, a woman would not be able to get pregnant again.
- Blood clots in the blood vessels
- Extensive bleeding
- Fetal distress
Some hospitals may not have the resources to perform VBAC or emergency cesarean deliveries. It is therefore important to discuss your options with your doctor to understand the pros, cons, and risks of natural birth after C-section.
Why is VBAC done?
Reasons for choosing VBAC may include:
- Positive effects on future pregnancies: If you are planning to have more children, VBAC can help reduce the risks of multiple cesarean deliveries in the future.
- Lower risk of surgical complications: A successful VBAC is associated with a lower risk of complications, such as excessive bleeding, infection, or formation of blood clots in one or more deep veins in the body (deep vein thrombosis). These blood clots in the veins can travel to the lungs, heart or brain, causing fatal complications. VBAC may also reduce the risk of surgical removal of the uterus (hysterectomy), as well as injury to surrounding abdominal organs (such as the bladder or bowel), muscles, nerves, and other tissues.
- Shorter recovery time: The hospital stay following VBAC is shorter than a repeat cesarean delivery since the recovery time is often shorter, allowing the mother to resume her normal activities sooner.
- Personal choice: Some women may simply want to experience a vaginal delivery.
Who is VBAC ideal for?
You may be a candidate for VBAC if you are:
- Pregnant with one baby and:
- Have a history of cesarean delivery with low transverse (horizontal) incision without complications
- Have no other contraindications
- Pregnant with one baby and:
- Have a history of cesarean delivery and an unknown uterine incision
- Have no other contraindications
- VBAC may not be done if it is suspected that you had a high vertical (classical) uterine incision in the previous cesarean delivery
- Pregnant with twins or triplets and:
- Have a history of low transverse cesarean delivery
- Are a candidate for twin or triplet vaginal delivery
When is VBAC not done?
VBAC is not recommended if you have a history of:
- High vertical (classical) uterine incision during the previous cesarean delivery
- Cesarean delivery with an unknown type of prior uterine incision or suspected classical incision
- Uterine rupture due to scarring from previous uterine surgeries
- Certain uterine surgeries, such as fibroid removal
- More than 2 previous cesarean deliveries
Other factors that may mean you can’t have a VBAC include:
- Your body mass index (BMI) is 40 kg/m2 or higher at the time of delivery and you have never had a single vaginal delivery in previous pregnancies.
- Labor is not progressing.
- You are at an advanced age.
- Your pregnancy continues longer than 40 weeks.
- You have preeclampsia (a dangerous complication of pregnancy characterized by high blood pressure).
- You have had previous cesarean delivery within the past 18 months.
- You have a closed cervix requiring labor induction.
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Guise JM, McDonagh MS, Hashima J, et al. Vaginal Birth After Cesarean (VBAC): Summary. 2003 Mar. In: AHRQ Evidence Report Summaries. Rockville (MD): Agency for Healthcare Research and Quality (US); 1998-2005. 71. https://www.ncbi.nlm.nih.gov/books/NBK11968/
American Pregnancy Association. Vaginal Birth After Cesarean: VBAC. https://americanpregnancy.org/labor-and-birth/vaginal-birth-after-cesarean-669
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