Is vaginal birth after C-section right for you? Here’s what you need to know about a VBAC

Whether your previous cesarean section (C-section) was planned or not, you might be hoping for a vaginal delivery this time around. You may have heard the old saying, “Once a cesarean, always a cesarean,” but that has been debunked. A vaginal birth after cesarean (VBAC) could be possible for you.

There are a few benefits to a VBAC delivery – an easier recovery, for starters. But there are also circumstances where labor or pregnancy complications may lead your doctor and care team to recommend another C-section for the safety of you and your baby.

Labor and delivery can be unpredictable, but your doctor can help you make a birth plan and determine if you’re a good candidate to try for a VBAC. Below, we’ll explain what a VBAC is and walk you through its benefits and risks. We’ll also explain how your doctor may determine if it’s right for you.

What is VBAC

VBAC simply means having a vaginal birth after having a C-section.

Another term often used is TOLAC (trial of labor after C-section). This is the process of trying to have a vaginal delivery after previously having a C-section.

Research from the National Institute of Child Health and Human Development shows that, “among appropriate candidates,” 75% of VBAC attempts result in vaginal births.

How a VBAC procedure differs from a routine vaginal birth

VBAC procedures aren’t very different from routine vaginal births. As the person giving birth, you don’t have to do anything different – the difference lies with your doctor. During labor and delivery, your doctor and medical team will monitor you and your baby more closely than they might if you hadn’t previously had a C-section. Because your previous C-section required an incision in your uterus, they need to pay extra attention to potential risks, which are covered below.

Benefits of VBAC

As the person giving birth, wanting to experience a vaginal birth requires no reason or explanation. Even so, it may put your mind at ease to know that there are several benefits to choosing a vaginal birth over a C-section, including:

• Avoiding abdominal surgery
• Less risk of complications from anesthesia
• Lower risk of infection
• Lower risk of excessive bleeding
• Lower risk of getting a blood clot after delivery
• Shorter postpartum recovery
• Lower risk of complications in future pregnancies

There is no set number of C-sections a woman can have, but more C-sections can lead to an increased risk of complications.

The benefits of a VBAC make it worth considering. However, it’s important to work with your care team to make sure you are an appropriate candidate and you understand the risks and benefits.

VBAC risks

Like all pregnancies, there are risks associated with trying to have a VBAC, but they are rare. Some of the potential risks of a VBAC are uterine rupture and uterine dehiscence.

Uterine rupture happens when the pressure of giving birth causes the incision from a previous C-section to tear. This can cause fetal complications and maternal hemorrhaging. The rate of uterine rupture is extremely rare, happening in less than 1% of VBAC patients.

Uterine dehiscence is an equally rare complication (0.06% to 3.8%) where – unlike a uterine rupture where all three muscular layers of the uterus open – only some of the uterine muscular layers open, making the amniotic sac and fetus visible.

VBAC procedures can be very safe for expecting mothers, but certain factors can affect whether your doctor recommends it. If you’re concerned about your chances of having a safe VBAC, schedule an appointment with your primary care doctor or women’s health specialist, like an OB-GYN.

Is a VBAC right for me?

There is no better way to determine whether a VBAC is right for you than by talking with your doctor about:

• Previous pregnancies and deliveries
• Reasons behind past C-section(s)
• Any other preexisting medical conditions
• Benefits and risks of trying for a VBAC vs. having a planned C-section
• Labor plans (spontaneous or inducing)
• Future pregnancy plans

This information will help shape their recommendation on whether you’re a candidate to try having a VBAC. In addition, having a VBAC is more likely if:

• You’ve previously had a vaginal birth
• You have no more than two prior C-sections
• You and your baby are healthy during your pregnancy
• Your baby is a “normal” size (average measurements in weight, length and head circumference)
• Labor starts spontaneously before or around your due date
• There has been at least 18 months between your C-section and the due date with the next pregnancy

Even if your doctor decides that you’re a good candidate for trying to have a VBAC, they’ll continue to discuss the benefits and risks throughout your pregnancy. This is in case a situation comes up that affects your ability to have a safe vaginal birth – including going past your due date, gaining significant weight during your pregnancy, developing pregnancy complications like high blood pressure or gestational diabetes, or the return of the condition that required your previous C-section.

When is a VBAC not recommended?

While the above conditions can affect the likelihood of success trying to have a VBAC, there are a few circumstances that could’ve happened before this pregnancy that make it more difficult for you to try a VBAC.

VBAC would not be recommended if:

• You’ve had a prior classical C-section (i.e., an incision into the myometrium layer of the uterus responsible for contracting during labor)
• You’ve had more than two C-sections
• You’ve had a uterine rupture or dehiscence in the past
• You have certain health conditions or pregnancy complications, like certain types of heart disease or placenta previa

How to prepare for VBAC and what to ask your doctor

Start by scheduling a prenatal appointment and talk to your doctor. They’re your resource to help you prepare for trying to have a VBAC. During your prenatal visits, consider asking them for help with writing a birth plan and recommendations for VBAC childbirth classes.

As you continue preparing, a VBAC childbirth class can increase your confidence. In these classes, which you can attend in person or online, you can learn about the stages of labor and delivery, pain management during delivery, coping techniques, early signs of labor and whether you want an epidural or unmedicated birth.

And while you build your labor and delivery plans, don’t be afraid to ask your doctor even more questions beyond your eligibility and health conditions. You can also ask questions about them, their experience and the facility. For example:

• How many VBACs have you attended this year? How many were successful?
• Do most of your planned VBAC patients have a VBAC?
• What resources are available at your hospital?
• How does your facility manage VBAC complications?

As an expecting parent, you should leave every appointment and enter your delivery room with the same feelings: peace, trust and confidence. Hopefully, these conversations and courses bring you one step closer.

Planning ahead

When you’re pregnant, your mind is likely filled with plans – names, nurseries and your birth plan. It can all feel overwhelming but know that your doctor and care team are also planning for a safe delivery for you and your baby. Vaginal births after a C-section are possible, and as you plan ahead, give yourself and your body grace even if your doctor recommends a C-section.

Talk to your doctor until you feel confident in your birth plan and choose a hospital-based birth center that’s prepared for every possibility during labor and delivery. The birthing process may not go exactly as you planned, but your medical team will be prepared to help you through the safest delivery for you and your baby.