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Vaginal Birth After C-Section (VBAC)

If you've previously had a C-section, you may still be able to have a vaginal birth. With a vaginal birth after a C-section (VBAC), you avoid the risks of multiple C-sections. With a VBAC, you can also recover faster from birth.

But VBACs aren't for everyone, as VBACs themselves carry risks. Here's what you need to know about what happens during a VBAC and whether a VBAC birth is right for you.

What Is VBAC?

A vaginal birth after C-section, or VBAC, is when you give birth vaginally after having a C-section for a previous pregnancy.

About 75 percent of people who attempt a VBAC are successful. The other 25 percent require emergency C-sections because of problems that occur during labor.

A VBAC has benefits and risks. Whether a VBAC is suitable for you depends on many factors.

How long after C-section is it safe to have a VBAC?

VBACs that happen within 18 months of a C-section have three times the risk of uterine rupture compared to those that happen later.

If it's been less than 18 months since your C-section surgery, that doesn't mean you can't have a VBAC. If your delivery is close to the 18-month mark, VBAC may still be a good choice. This is especially true if you don't have other risk factors for uterine rupture, such as obesity or multiple previous C-sections.

What are the benefits of a vaginal birth after C-section?

The benefits of a VBAC include the following.

  • Shorter recovery time — You'll recover faster after a VBAC birth than you would with a C-section.
  • The chance to experience a vaginal birth — This is something that may be important to some people, but not everyone.
  • Avoiding C-section risks — If your VBAC attempt is successful and you don't need a C-section, you'll avoid the risks of a C-section. These include blood loss, infection, injury to the baby, and others.

What Are the Risks and Complications of Natural Birth After C-Section?

The main risk of a VBAC birth is uterine rupture. This is when the uterus tears open, usually at the site of the previous C-section scar. A uterine rupture requires an emergency C-section and surgical repair of the uterus.

Sometimes, it requires the removal of the uterus. Without timely treatment, a uterus rupture can cause fetal death. This is extremely rare, as doctors recognize signs of a uterus rupture and respond right away.

The risk of a uterus rupture happening during a VBAC is less than half a percent if you only had one prior C-section with a low transverse (horizontal) incision.

In about 25 percent of people, a VBAC won't work. Labor may progress too slowly, or the baby's heart rate drops too much. These cases require an emergency C-section.

The risk of infection and bleeding is higher for an emergency C-section than for a scheduled C-section.

How can I increase my chances of VBAC success?

You can increase your chances of VBAC success by:

  • Walking or jogging during pregnancy — One study found women who walked or jogged at least 200 minutes each week were more likely to have a successful VBAC.
  • Maintaining a healthy pregnancy weight — Gaining more than 40 pounds in pregnancy increases the chance you'll need a repeated C-section.
  • Attending childbirth classes — This will help you recognize the signs of labor and learn about birthing options.

How do I know if a VBAC is right for me?

You and your doctor should consider many different factors when deciding on a VBAC.

These include:

  • How many more pregnancies you want to have — If you plan to have more pregnancies, a VBAC may be a good idea for you. The risks of bleeding, bowel injury, and infection increase the more C-sections and scar tissue you have.
  • How many previous C-sections you've had — Doctors don't recommend VBAC if you've had more than two C-sections. That's because each previous C-section increases the risk of uterine rupture during a VBAC.
  • Pregnancy complications — If you have certain pregnancy complications, the risks of VBAC may outweigh the risks of a C-section. This includes gestational diabetes, preeclampsia, and other pregnancy complications.
  • Reasons for your previous C-section(s) — If you had placenta previa or a breech fetal position that required a C-section, that isn't likely to happen again. But if you needed a C-section because of slow or stalled labor, there's a higher chance this could happen again. Your doctor can advise you more about the likelihood you'll need a repeated C-section with your pregnancy.
  • The size of the fetus — You're less likely to have a successful VBAC if your fetus is large, especially in relation to your pelvis.
  • What kind of C-section incision you have — If doctors did a low transverse incision into your uterus for your last C-section, you're at a lower risk of uterine rupture. Low vertical incisions have higher risks of rupture during VBAC, but VBAC may still be possible. High vertical incisions have the highest risk of rupture, and doctors don't advise VBAC in these cases. The incision in your skin may differ from the one in your uterus — check your medical records for the type of uterus incision you had.
  • Whether you have had other previous surgery on your uterus — If you had another uterus surgery (to remove a fibroid, for example), the risk of uterine rupture with a VBAC could be too high.
  • Whether you've given birth vaginally before — If you gave birth vaginally before your C-section, the chances of a successful VBAC are higher.
  • Whether you need an induced labor — If you need a labor induction, the risk of uterine rupture increases as induction can cause stronger uterine contractions. This doesn't mean you can't have a VBAC, but it's essential to factor in the added risk to your decision.
  • Your age — If you're over 40, the chance is higher that you will need an emergency C-section if you attempt a VBAC.
  • Your weight — Those with obesity are less likely to have a successful VBAC.

What Should I Expect During VBAC?

Here's what you can expect before, during, and after a VBAC at a hospital. VBACs require extra planning and monitoring. Otherwise, however, they're very similar to a routine vaginal birth.

It's not safe to have a VBAC at home. That's because if you need an emergency C-section and don't get one quickly, you and your baby are in serious danger. You should only try a VBAC at a hospital that will have a team ready to perform an emergency C-section if needed.

Before

Your doctor will counsel you on the benefits and risks of a VBAC based on your health, current pregnancy, and past births.

You'll prepare as you would any labor: packing your hospital bag and preparing any recovery essentials you'll need when you return home. Make a plan for who will care for your other children while you're in the hospital.

Toward your due date, your doctor might check your cervix for signs that labor might start in the coming days. They may perform one or more membrane sweeps, which are where they separate the uterus away from the cervix using gloved fingers. This can sometimes help trigger labor.

If you don't go into labor before 40 weeks, the chance of a successful VBAC decreases. At the same time, inducing labor with medication increases the risk of uterine rupture with a VBAC.

You and your doctor may decide to only go ahead with a VBAC if you go into labor before a certain date and don't require induction. Or, you may decide you wish to go ahead with a VBAC even if you do need induction.

In this case, your doctor should avoid using induction medications like misoprostol or dinoprostone. These medications can induce stronger contractions than other forms of induction and increase the risk of uterine rupture. Instead, doctors should use mechanical methods to ripen the cervix and low-dose oxytocin for induction.

During

A VBAC happens much like a regular vaginal birth. The critical difference is that doctors will monitor you more closely.

They may want you to come to the hospital as soon as you feel contractions, even if your contractions are far apart. If your water breaks, you should go to the hospital even if you don't feel contractions.

Your team will use a continuous fetal heart rate monitor to ensure your baby isn't distressed. This is a sensor held on to your belly with an elastic band. If the monitor is wireless, you can walk around during labor. If not, you may have to stay on or near the hospital bed.

If the fetal heart rate drops too low or stays low for too long, you may need an emergency C-section. Your health team will also monitor you for signs and symptoms of problems. These include pain between contractions and vaginal bleeding.

You can request an epidural or another form of pain medication at any time. An epidural doesn't reduce your chance of success with a VBAC.

As long as the fetal heart monitoring shows the baby is doing well and you don't show any signs of problems, you can continue laboring. When you're ready to push, you can push just as you would for a first-time pregnancy. You'll be able to hold your baby right away after VBAC, as long as neither of you needs medical care.

Recovery after VBAC

A recovery after a VBAC is usually the same as a routine vaginal birth recovery. You will stay at the hospital for two nights for care and monitoring. If doctors are worried about your health, you may need to stay at the hospital longer.

It takes about six weeks to recover from a vaginal delivery. You will have bleeding or spotting, called lochia, for weeks. People generally have less pain when recovering from a vaginal delivery compared to a C-section.


Last reviewed by a UPMC medical professional on 2024-09-05.