VBAC Birth: What Could Be Safe and Unsafe

Medically reviewed by Sanaz Ghazal, MD

"VBAC" means "vaginal birth after cesarean." It's often safe to deliver vaginally if you've previously had a cesarean (C-section). VBACs have been on the rise, up 16.2% in recent years.

When deciding between a VBAC and a repeat C-section, it's important to know the risk of complications and potential benefits of each option. Your healthcare provider can help you understand your risks and whether you would be a candidate to consider VBAC.

This article discusses the benefits and risks of VBAC and the factors that affect when it's safe and when it's not safe.

Will My Provider Do VBAC Birth?

If you've had a C-section in the past, you can request either a trial of labor after cesarean (TOLAC) or an elective repeat cesarean delivery. The risk of having a TOLAC depends on the circumstances of your previous C-section and your current pregnancy.

Discussing options with your healthcare providers as early as possible is important. They might say no to a VBAC because you're at high risk of complications. Some hospitals don't have the resources to offer VBAC delivery. Others may not want to take on the liability.

Takeaway

Planning for a VBAC that doesn't happen can stir up many emotions. Give yourself time to heal and accept what happened. In the meantime, it may help to speak with others who have had a similar experience.

Depression is common after pregnancy. And some research suggests that unplanned or emergency C-sections play a role in depression and postpartum PTSD (post-traumatic stress disorder). If you have feelings of depression, contact your healthcare provider right away.

VBAC Birth Does Succeed: Delivery Rates

More than 60% to 80% of VBACs are successful. Your chances of success might be higher if:

• You've previously given birth vaginally.

• You've only had one C-section, and it was a low, side-to-side incision.

• You and your baby are currently in good health.

• Labor starts on its own (not induced) close to your due date.

Potential benefits of VBAC over another C-section are:

• No need for abdominal surgery

• Faster recovery

• Lower risk of infection and blood loss

• Avoids potential complications of multiple C-sections, such as bowel or bladder injury, hysterectomy, and problems with the placenta in future pregnancies
  

When compared with repeat C-sections, VBAC is relatively safe.

When VBAC Delivery Poses More Risks

For some, VBAC delivery is less risky than a repeat C-section. But for others, it's a high-risk choice. One key factor is the type of incision from your earlier C-section, which can weaken the uterus. The types of incisions include:

• Low transverse: An incision that goes side-to-side across the lower part of the uterus has the lowest chance of rupturing in a future delivery.

• Low vertical: A low up-and-down incision has a higher risk of rupture than low transverse.

• High vertical: An up-and-down incision on the upper part of the uterus has the highest risk of future rupture.

You can't always tell which type of incision you had based on the scar on your skin. Your provider will need to see records from your C-section.

Uterine Rupture

Uterine rupture is life-threatening for you and your baby and requires an emergency C-section. However, uterine rupture is not common, even in a VBAC. It has a worldwide incidence of only 0.07%. It's rare in developed countries, likely due to a thorough assessment of risk factors before attempting VBAC.

VBAC may also be riskier if:

• You're past your due date.

• Labor is induced.

• You have a high body mass index (BMI).

• You have a hypertensive disorder such as preeclampsia.

• You've not delivered vaginally before.

• There's fetal distress.

• The baby is very large or in a difficult position.

• There were less than 18 months between pregnancies.

If an attempted VBAC doesn't result in vaginal delivery, the risk of complications may be higher than with an elective repeat C-section.

VBAC Birth Timing: When to Get Pregnant

The risk of uterine rupture may be higher if you get pregnant less than 18 months after your last pregnancy. It's a good idea to confirm this with your healthcare provider.

Working With Your VBAC Birth Team

First, you'll need to find providers willing to consider VBAC. Depending on your personal preferences, these may include:

• Ob-gyn (obstetrician-gynecologist); A doctor specializing in pregnancy and childbirth

• Certified midwife or certified nurse-midwife: Trained healthcare providers who assist in pregnancy, labor, and delivery and can provide primary care

• Doula: A trained professional (not a medical professional) who offers emotional and physical support during pregnancy and childbirth

• Hospital or birthing center: The staff is equipped to handle emergencies
  

Regarding home birth vs. hospital, experts believe each pregnant person has the right to make the decision. However, they recommend that a TOLAC occur in a facility with trained staff and the ability to perform an emergency C-section within a safe time frame.

Each birth experience is different, so it's hard to say whether a VBAC is more or less painful than any other delivery. Risk factors are subject to change during pregnancy, labor, and delivery. In the hospital, it will be similar to other vaginal deliveries, but you'll likely have continuous monitoring to address any signs of distress immediately.

VBAC Birth Support and Resources

If you are considering VBAC and don't have a provider, ask for information and referrals from a general healthcare practitioner or other medical professional. Ask around among family and friends to see if other people in your network have had a VBAC and what advice they can offer.

You can also check out the International Cesarean Awareness Network (ICAN), an advocacy organization with chapters throughout the United States and worldwide.

Summary

In most cases, it's safe to deliver vaginally if you've previously had a C-section. There are some exceptions, though. One key factor is the type of incision you had for your C-section. Because of some risks, not all providers are willing to try VBAC. Discussing your birth plan with providers early on is best so you have time to seek other care. Whatever your birth plan, remember that it's unpredictable and may have to change.