What is a VBAC?
vaginal birth after cesarean, or VBAC, is a birthing option for many women who
have previously had:1
- One cesarean delivery.
- One or two
cesarean deliveries and a past vaginal delivery.
When you go into labor with the plan to deliver vaginally, it is
called a "trial of labor."
Is a VBAC trial of labor a good choice for you?
Delivering a baby vaginally after having one cesarean, or after
having a vaginal delivery and two cesarean deliveries, is a safe choice for
most women. Whether it is right for you depends on several factors,
- Why you had a cesarean previously. If you had
a cesarean because of a problem that you now have in this pregnancy (such as a
breech baby), a trial of labor is generally not
recommended. However, most women have cesarean deliveries because of problems
that develop during labor (not before labor), such as stalled labor or signs of
fetal distress. Usually there is no reason to expect that the same problem will
happen again (although it may).
- How many cesarean deliveries you
have had. If you have had one cesarean, a trial of labor is generally safe. If
you have had two cesareans, a trial of labor is only
considered safe if you've also delivered vaginally
before. A trial of labor is not recommended for women
who have had more than two cesareans. The more cesarean deliveries you have
had, the higher your risk of
uterine rupture (though the risk is still low) and
problems with the placenta that may cause difficulties during delivery.
- How many future pregnancies you are planning. The risks of
complications during pregnancy and surgery increase with the number of cesarean
scars you have.
- Your personal preference. If there is no medical
reason for a repeat cesarean, the choice is yours. Women in similar situations
may make different choices based on their own experiences and
- The hospital where you will deliver. In order to offer
VBAC, a hospital must have the staff and the equipment to do rapid emergency
cesarean at any time of the night or day.
What are the risks of VBAC?
Risks of a VBAC trial of labor include:
- Development of a typical labor problem (such
as fetal distress) that requires a cesarean delivery to ensure your own or your
infant's safety. This occurs in about 20% to 40% of women who are considered
good candidates for a VBAC trial of labor.1
- Separation of the uterine scar (dehiscence). This
usually causes no problems and, in some cases, is not even detected. It usually
heals on its own.
Uterine rupture, which can be
life-threatening to mother and infant, although it is rare.
Women who have a trial of labor and then deliver by cesarean have
a higher risk of infection. This means that infection risk is lower after a
vaginal birth, and after a repeat cesarean without labor.1
No two births are alike, and the labor and delivery process is
impossible to fully plan and control. No doctor can guarantee that you will
have a successful trial of labor.
What are the risks of a cesarean delivery?
The risks of cesarean delivery include:
- Blood loss that
- Genital or urinary
- Blood clots (thromboembolism).
related to anesthesia.
- Fetal injury during the delivery. The injury
usually is not serious.
- A longer recovery time.
Future risks. With each surgery on the
uterus, more scar tissue forms. If you are planning on a pregnancy after this
one, scarring is an important factor to think about. After you have two scars,
each additional scar in the uterus raises the risk of placenta problems in a
later pregnancy, such as
placenta previa or
placenta accreta. These problems raise not only the
risks for a baby but also your risk of needing a
hysterectomy to stop bleeding.2
If you need more information, see the topics
Vaginal Birth After Cesarean (VBAC) and