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Vaginal Birth after Cesarean (VBAC)

If you have already had a cesarean birth, you will have some choices to make for your next delivery.

Women who deliver vaginally usually have less postpartum discomfort and shorter hospital stays than those who have a cesarean birth (C-section).

Some women who have already had a C-section choose to deliver in the same way for another pregnancy. They may not want to go through labor, or may not want to risk a tear in the uterus during vaginal birth.

Your future childbearing plans are important. If there is even a small chance you may become pregnant again, a VBAC may be the better choice. If the VBAC is successful, there is a lower risk of serious problems with how the placenta attaches to the uterus in future pregnancies.

Is VBAC Possible?

Many times, the location of the cesarean scar in your uterus (womb) helps determine whether VBAC will be a good option. Your doctor or midwife will review the records of your previous births to locate your uterine scar.

  • For most women, their surgical scar is located in the lower part of the uterus. This location means there is a lower risk of the uterus tearing during a vaginal birth.
  • If the scar is in the upper part of the uterus (where contractions occur), you will be at higher risk for uterine problems during a vaginal birth.
  • Women who have had two cesarean births and no vaginal births, or more than two cesarean births, have an increased risk of the uterus tearing during labor. We recommend another cesarean birth in such cases.

Having a Successful VBAC

You will have the best chance of a successful VBAC if:

  • Your cesarean birth was performed because of factors such as breech presentation, not because of problems during labor
  • You are under 30 years old
  • You have already had a vaginal birth
  • Your labor started on its own (labor wasn't induced by medication)
  • You deliver on or before your due date
  • Your cervix is at least 2 centimeters dilated and very thin (in proper condition for childbirth) when you are admitted to the hospital

Benefits of Vaginal Birth

Compared with a cesarean birth, a woman having a vaginal birth will often:

  • Have a shorter hospital stay
  • Have a lower risk of problems caused by surgery (such as infection, damage to the bladder or other internal organs, or high blood loss)
  • Have a lower risk that the baby will have breathing problems
  • Enjoy a quicker return to normal activities
  • Have a greater chance of having a vaginal birth in future pregnancies
  • Have a lower risk of serious problems with how the placenta attaches to the uterus in future pregnancies

VBAC Risks

Risks to the mother

  • A tear in the uterus occurs in 5 to 10 women out of every 1,000 who try VBAC (.5 to 1 percent).
  • Blood loss. This may require a transfusion.
  • The need for a hysterectomy (removal of the uterus)
  • Damage to the bladder or other internal organs
  • Infection
  • Blood clots

Risks to the baby

There is a small chance that the baby may suffer brain damage or die. However, damage to the baby because of uterine tears happens in less than 1 out of 1,000 VBAC attempts (less than .1 percent).

Factors that increase the chance of the uterus tearing

  • Induced labor
  • More than one previous cesarean section
  • Less than 18 months since the last cesarean delivery
  • Need for medicine during labor to increase contractions

Risks compared to planned cesareans

If you attempt VBAC but need a cesarean section, you will have the same risks as a planned cesarean delivery; however, the risk of infection, blood transfusion, blood clots, and hysterectomy is greater than for a vaginal delivery.

Although most tears occur during labor, there is a small risk (2 in 1,000, or .2 percent) that the uterus will tear before a planned cesarean birth. The risks to the baby and mother are the same as if the uterus tore during a VBAC.

  • Women who have a successful VBAC have a lower risk of complications when compared to those who have repeat cesarean sections, but overall, the risk of blood transfusion, hysterectomy, blood clots, and infection is increased in women who attempt VBAC. This is because women who end up needing a cesarean section are at greater risk of complications during surgery.
  • The risk of the baby dying or being seriously injured during VBAC is 4 in 1,000 (.4 percent). The same risk during a planned cesarean birth is 1 in 1,000 (.1 percent).

If You Choose VBAC

If you decide to try to deliver your baby vaginally after having a previous C-section birth:

  • You will be asked to sign a consent form showing that you understand the risks and benefits of your choice.
  • Once you enter active labor, we will monitor your contractions and the baby's heart rate. Active labor starts when your cervix is 4-5 centimeters dilated.
  • You will have an IV for whatever fluids and medications you may need during labor.
  • You may choose to use any pain medication options we offer during labor, including an epidural.
  • You may change your mind about delivering vaginally during labor. Please keep in mind that if you are very close to delivery, there may not be time to do a cesarean birth.
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