Vaginal Birth after a Previous Cesarean Section

What is a vaginal birth after a previous Cesarean section?

If you previously gave birth to a child by cesarean section (C-section), there is a good chance you will be able to deliver your next child vaginally. This is called a vaginal birth after a cesarean section, or VBAC. Your healthcare provider may encourage you to try a vaginal birth. Labor and vaginal delivery are generally safer for you than the surgery required for a C-section.

What is a trial of labor?

Your healthcare provider may recommend a trial of labor. This means you should go to the hospital when your labor begins or when your bag of waters breaks. Your labor will be monitored. You will continue your labor and a vaginal birth if there are no signs of problems that make a C-section necessary. You may need to have a repeat cesarean birth if there are signs of:

• abnormal bleeding
• abnormal fetal heart rate patterns
• failure to make good progress in labor.

When can a VBAC be done?

Your healthcare provider will consider what happened during your last delivery or deliveries to decide whether you should have a trial of labor. The main concern relates to the scar left in your uterus by the C-section. You do not want it to come apart during labor or birth. Your provider will encourage and allow you to have a trial of labor if:

• You have had only 1 previous C-section. If you have had more than one, a C-section will be necessary no matter what the previous incision.
• The cut in your uterus was horizontal (crosswise) rather than vertical when you had the C-section. Your provider will look at your medical records to see which type of cut you had.
• A delivery room, anesthesia, and a doctor are immediately available in case there are any problems or an emergency C-section needs to be done.
• Your pelvis is large enough for a vaginal birth.
• You have no other uterine scars or previous ruptures of the uterus.
• When prostaglandins are not needed to soften the cervix.

VBAC is not recommended for all women. For example, your healthcare provider will not allow a trial of labor if:

• An immediate emergency cesarean delivery could not be done, if needed, because a surgeon, anesthesia, or sufficient staff are not available at the hospital.
• For a previous C-section, you had a vertical or T-shaped cut in the uterus.
• If the pregnancy has gone beyond 40 weeks, there is less chance that VBAC will be successful.
• You have had 2 previous C-sections.
• You have had a tear in your uterus.
• You have a complication in your pregnancy that suggests that labor would not be safe for you or the baby.
• You are expecting more than 1 baby (for example, twins).
• Your baby is in the breech position (the baby's bottom or feet are down first instead of the head).
• You have a pelvis that is too small for a vaginal birth.
• You or the baby have medical problems that would make a C-section safer.
• Prostaglandins are needed to soften the cervix to induce labor, as there is an increased risk of rupturing the uterus.

Oxytocin alone may be used to induce labor for VBAC.

If it is expected that your baby will weigh over 8.8 pounds (4000 grams), this does not necessarily mean that you cannot have a trial of labor. It does mean that your provider will need to watch your labor and delivery very closely.

What are the benefits?

These are the reasons it is good to try to have a VBAC instead of a C-section:

• Less risk. Vaginal deliveries have fewer risks for you and the baby than cesarean delivery. Vaginal deliveries require fewer blood transfusions and result in fewer infections. There is less risk of a blood clot moving to the lungs.
• Shorter recovery time. Your hospital stay is shorter and your recovery at home is faster with a lot less discomfort.
• More involvement. You and your family can be more involved with the birth. Excellent pain relief, such as an epidural, which numbs the lower half of the body, may be used during a vaginal birth.
• Usually less cost.

What are the risks associated with a VBAC?

The biggest risk for both you and the baby is that the scar from the previous C-section will tear and rupture the uterus during labor. However, the risk of uterine rupture is low. The risk is about 1.5% or less in women who have had 1 previous C-section. If any signs of rupture do occur during labor, an emergency C-section will be done. An emergency C-section does carry more risk of infection and other problems than a scheduled cesarean delivery. If a trial of labor fails (VBAC), there is an increased risk for rupture of the uterus, hysterectomy, blood transfusions, infection of the uterus, and increased problems for the mother and baby after delivery.

What should I discuss with my healthcare provider?

If you have had a C-section, talk to your healthcare provider about the possibility of a vaginal delivery for your next baby. Be sure to discuss the risks and whether or not you are a good candidate for a VBAC. Find out whether the hospital where you plan to deliver is prepared for an emergency C-section and emergency infant care if necessary.