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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.
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.
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.
The benefits of a VBAC include the following.
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.
You can increase your chances of VBAC success by:
You and your doctor should consider many different factors when deciding on a VBAC.
These include:
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.
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.
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.
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.
By UPMC Editorial Staff. Last reviewed on 2024-09-05.
