Whether you deliver vaginally or by cesarean section, you are unlikely to have serious complications. Overall, a routine vaginal delivery is less risky than a routine cesarean, which is a major surgery. However, researchers have found that pregnant women who have a cesarean scar on the uterus have a slight risk of the scar breaking open during labor. This is called uterine rupture.¹

Although rare, uterine rupture can be life-threatening for both mother and baby. Therefore, women with risk factors for uterine rupture should not attempt a vaginal birth after cesarean (VBAC).¹

Risks of VBAC

The risks of VBAC include:

• An unsuccessful trial of labor that ends with a cesarean delivery (most common complication). Up to 40% of women who attempt VBAC develop a problem that requires a cesarean delivery.¹ Stalled labor (called dystocia) or fetal distress are common examples of problems that require a cesarean. A cesarean after a trial of labor increases the risk of infection for both the mother and baby.¹
• A slight separation of an existing cesarean scar (called dehiscence). This usually causes no problems and in some cases is not even detected. The separation usually heals on its own.
• A slight risk of uterine rupture, which can be life-threatening for the mother and the baby.⁶ A uterine rupture is very rare yet very serious. If the rupture cannot be repaired quickly, removal of the uterus (hysterectomy) may be necessary to prevent severe blood loss.

The possibility of uterine rupture is influenced by the:

• Type of incision used for the previous cesarean. Scarring above the thinner, lower uterus is more likely to rupture. A low, side-to-side (transverse) incision is least likely to rupture. About 5 out of every 1,000 women (0.5%) with one low, transverse incision scar have a uterine rupture during labor when the labor starts on its own without medicine.² It is likely that these women have other risk factors that raise their chances of having this complication.
• Number of surgical uterine scars a woman has, especially if the cervix is not softened and opening (dilating). The risk of rupture increases with each additional cesarean scar. One study has shown that while a uterine rupture occurs in up to 8 out of 1,000 women with one scar, up to 37 out of 1,000 women with two scars develop a rupture.⁷
• Use of medicine to start (induce) labor. Among women who are otherwise good candidates for VBAC, the greatest risk factor for rupture is the use of misoprostol (Cytotec) to start (induce) or strengthen labor.^{2, 1} Aiding a slow labor (augmentation) with careful use of oxytocin (Pitocin) has rarely been linked to uterine rupture.⁸

Should I have a VBAC trial of labor after a previous cesarean?

Risks of any cesarean