Information, preparation, and teamwork are needed for a successful vaginal birth after cesarean (VBAC).

Childbirth and VBAC education

To prepare for labor, consider taking a childbirth education class at your local hospital or clinic. You and your birthing partner can learn:

• What to expect during VBAC labor and delivery.
• How to manage the birth using controlled breathing and emotional and physical support.
• What medical pain control options may be available for a vaginal delivery.

Labor

Other than requiring closer monitoring, labor for a VBAC is the same as normal labor. During early labor, a woman can remain as active and mobile as she feels comfortable with. There are no specific restrictions for VBAC until active labor begins. During the active period of labor, continuous fetal heart monitoring is done to watch for early signs of fetal distress or uterine rupture. (For more information, see the Exams and Tests section of this topic.)

• If you are attempting VBAC and you have not had a previous vaginal birth or your previous cesarean was done early on in labor, your labor will be like a first-time labor. For example, it could take a long time.
• If you have previously had a longer trial of labor or have delivered vaginally, your body is likely to have adapted to the process, making labor easier.

For more information about labor and delivery, see the topic Labor, Delivery, and Postpartum Period.

Medications for starting or strengthening VBAC labor

Some doctors avoid the use of any medicine to start (induce) a VBAC trial of labor. Other doctors are comfortable with the careful use of oxytocin (Pitocin) to start labor when the cervix is soft and opening (dilating). VBAC studies have shown that inducing or strengthening labor with misoprostol (Cytotec) increases the risk of uterine rupture.²

If your labor slows or stops progressing, your doctor may use oxytocin to strengthen (augment) contractions. The sparing use of oxytocin (Pitocin) is an accepted and common practice for a stalled VBAC trial of labor and is rarely linked to uterine rupture.⁸

Pain medication

As with most vaginal births, most women who choose VBAC can safely use pain medicine during labor.

Pain medicine usually is started when the cervix has opened (dilated) 3cm to 4cm. Types of pain medicines used include:

• Local anesthesia, which numbs the small area where the medicine is injected.
• Regional (epidural) anesthesia, which partially or fully numbs the entire lower part of the body.
• Sedatives, which help you relax and sleep but do not relieve pain.
• Opioids (narcotics), which help you relax and partially relieve pain.