Vaginal Birth After Cesarean Section (VBAC)

What Is Vaginal Birth After Cesarean (VBAC)?

Having had a C-section in the past doesn't mean you must have one for each subsequent birth. Many women can safely have a vaginal birth after cesarean. It's important to ask your health care provider if vaginal birth after cesarean is an option for you and to discuss the risks and benefits.

When you go into labor, you and your doctor will prepare for a vaginal birth. You will start with a trial of labor after cesarean section (TOLAC). If all goes well, you can continue through the vaginal birth. However, if you or your baby face any risks, your doctor may decide if a C-section is the safest method of delivering your baby.

Is VBAC right for you?

Certain factors affect whether you are likely to have a successful vaginal birth. Delivering vaginally will allow you to avoid further scarring on your uterus, and you will have less pain and a shorter recovery time than with a C-section.

Not everyone is a candidate for VBAC, so you'll need to work closely with your health care provider throughout your pregnancy to ensure your circumstances make this a safe option. Many women have the option of a vaginal birth, even if you're pregnant with twins. Here's what you should discuss with your doctor:

• Your preferences: As long as there isn't a medical reason requiring a C-section, you have the option of trying vaginal delivery.
• Reason for your prior C-section: Often, a C-section becomes necessary because of complications during delivery. Each birth is different, so you may have different circumstances this time and may be better-positioned for a successful vaginal delivery.
• Delivery history: Discuss any successful vaginal deliveries you've had in the past.
• How many C-sections you've had: The biggest risk is that the C-section scar could tear open. This risk increases with each C-section.
• How many pregnancies you plan to have: Each C-section increases the risk of problems in future deliveries. Having a vaginal birth this time may benefit you for future pregnancies.
• Your birthing center: VBAC does carry risks, so you want to make sure you're delivering in a center that has experience with this type of delivery and that can perform an emergency C-section if needed.

VBAC risks and complications

To be as prepared as possible, discuss any potential VBAC risks with your doctor:

• Rupture of C-section scar: This is the biggest risk and poses a danger to you and your baby. The chances of the scar tearing are low; however, if you've had multiple prior C-sections, this risk increases.
• Emergency C-section: There's no guarantee that you will be able to deliver vaginally; problems could arise during delivery. These problems may require your doctor to perform a C-section.
• Infection: Needing a C-section after a trial of labor increases your risk of infection compared with a vaginal birth or planned C-section, although the overall risk is still low.

You may have a lower chance of having a successful vaginal birth if you:

• Are older than 35
• Are obese
• Had a previous C-section because of difficult labor
• Have a baby estimated to weigh more than 9 pounds
• Had your last pregnancy less than 18 months ago

How to prepare for Vaginal Birth After C-Section

Prepare as you would for a vaginal birth by attending childbirth classes and learning techniques for laboring and relaxation. Communicate throughout your pregnancy with your health care provider to ensure that it is still healthy for you to deliver vaginally. You may want to complete our birth plan guide to help share your expectations with your health care providers and nurses. Because you never know what may happen, it helps to be mentally and emotionally prepared for the possibility of a C-section.

What to expect during VBAC

• Trial of labor after cesarean (TOLAC): This follows like normal labor, where you can move around. Your care team will monitor you closely to ensure you and your baby are safe. Your chances of a successful vaginal delivery are higher if your labor begins on its own.
• IV preparation: You will receive an IV in your arm to deliver medications and fluids as needed.
• Medications for strengthening labor: If your labor begins to slow, your doctor may administer oxytocin to boost contractions.
• Pain medicine: If you choose to have an epidural or other pain-control options, your care team will offer it to you.
• Delivery: If all goes well, you will have a successful vaginal delivery.

You can have skin-to-skin contact with your baby right away and begin breastfeeding if you choose.

VBAC recovery

Your recovery is similar to a normal vaginal birth. Most moms stay in the hospital 24 to 48 hours. While in the hospital, your care team will look after you and your baby. Your vaginal area will be sore at first, and you may use ice packs to ease the pain and swelling.

For the first few days or even weeks, you will have some bleeding or spotting. It may take four to six weeks before you start feeling normal again and are able to return to work. Take it easy during this time. Avoid heavy lifting and rest as much as you need to. Your health care provider will give you specific instructions for caring for yourself at home.

VBAC at UPMC Magee-Womens Hospital

Many women who plan on vaginal birth after cesarean are successful. UPMC Magee-Womens Hospital has experience guiding women through the process and preparing them for a successful vaginal delivery. We have the latest technology and equipment to respond quickly to any risks or complications.

To find out more about the vaginal birth after cesarean procedure at Magee, call 1-866-MyMagee (696-2433) to speak with one our experts.

Learn More from our Health Library:

• Vaginal Birth after Cesarean
• Should I Try VBAC?

Learn More from our HealthBeat blog:

• 5 Things to Expect After Giving Birth