Vaginal birth after cesarean | March of Dimes

If you’ve already had a cesarean birth (also called c-section), you may be able to have your next baby vaginally. This is called vaginal birth after cesarean (also called VBAC).

You may be able to have a VBAC if your pregnancy is healthy and the incision (cut) in your last c-section was low transverse.

VBAC isn’t safe for all women. Talk to your provider to make sure it’s right for you and your baby.

If you are able to have a VBAC, there are some benefits like needing less time to recover and not needing surgery. 

Not all providers, hospitals and birthing centers offer VBAC. Talk to your provider to see if VBAC is available where you’re planning to have your baby.

If you’ve already had a cesarean birth (also called c-section), you may be able to have your next baby vaginally. This is called a vaginal birth after cesarean (also called VBAC). Cesarean birth is surgery in which your baby is born through a cut that your health care provider makes in your belly and uterus.  

More than 6 to 8 out of 10 women (more than 60-80 percent) who try VBAC are successful in having their baby vaginally. Talk to your health care provider early in your pregnancy to find out if VBAC may be a good choice for you and your baby.

How do you know if having a VBAC is right for you?

Talk to your provider if you’re thinking about having a VBAC. Your provider can help you look at the risks and benefits. If your risks are low and your chances of having a successful VBAC are high, then you may decide that VBAC is right for you.

Your chances of having a successful VBAC are better if:

• You’ve had a vaginal birth before. 
• You’ve had just one c-section in the past with a low transverse incision (also called a bikini cut).
• This means the cut was horizontal (side-to-side) and low on the uterus. This is the most common kind of c-section incision. It usually bleeds less than other incisions. It also makes a stronger scar on the uterus, which makes it less likely to tear.  
• You and your baby are in good health during pregnancy. 
• Your labor starts on its own just before or on your due date.

Your chances of having a successful VBAC are worse if:

• You have the same condition in this pregnancy that made your c-section necessary in a past pregnancy. For example, your baby has problems with his heart rate or is lying sideways in the womb. 
• You’re past your due date or your labor is induced.  
• You’re obese or you gained excessive weight during pregnancy. If you’re obese, you have an excess amount of body fat and your body mass index (also called BMI) is 30 or higher. To find out your BMI, go to www.cdc.gov/bmi.
• You have preeclampsia. This is a condition that can happen after the 20th week of pregnancy or right after pregnancy. It’s when a pregnant woman has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working properly. Signs of preeclampsia include having protein in the urine, changes in vision and severe headache.
• There’s less than 18 months between your last pregnancy and your current pregnancy (called a short interpregnancy interval).
• Your baby is very large. 
• Your provider, hospital or birthing center isn’t prepared to handle an emergency c-section if you need one. Talk to your provider about the level of medical care that’s available in the hospital or birthing center where you plan to have your baby.  
• You’re older than 35 or a race other than white. 
• Some providers may not offer VBAC if you’ve had more than two past C-sections or if you are pregnant with triplets or a higher number of multiples 

It’s not safe to have a VBAC if:

• You had a c-section in the past and your incision was not low transverse and instead was high vertical. A high vertical incision cuts up and down through muscles in the upper part of the uterus that strongly contract during labor. This can lead to a uterine rupture (tear in the uterine muscle).
• You had a uterine rupture in a previous pregnancy. This is when the uterus (womb) tears during labor. It happens very rarely.
• You’ve had certain types of surgery on your uterus. 
• You have certain health conditions or complications during pregnancy, like diabetes, heart disease, genital herpes or placenta previa, that make a c-section necessary.

What are the benefits of having a VBAC?

Having a VBAC has some benefits, including:

• There’s no need for surgery.
• Your recovery time is shorter than after having a c-section.
• There’s less blood loss.
• Your risk is lower for infection and other complications, like problems with the placenta called placenta previa and placent acreta.
• If you’re planning to have a lot of children, there’s less risk of complications from repeated surgeries, including scarring or injuries to the bowel or bladder. 
• You may want to have the experience of a vaginal delivery. 

What are the risks of having a VBAC? 

VBAC can have some risks, even if both you and your baby are healthy during pregnancy. These risks include:

• Your labor doesn’t go well and you need a c-section anyway. 
• Infection, injury and blood loss
• Your uterus ruptures (tears).  This is rare, but it can be life-threatening.

How do I prepare for a VBAC?

• If you previously had a C-section and you’re pregnant, talk to your provider about VBAC at your first prenatal visit.
• You may be able to take a childbirth class on VBAC.
• Be flexible and know that sometimes complications can happen that require needing a C-section. Ask your provider if your hospital of delivery has what it needs in case of an emergency C-section. A home delivery is not appropriate for VBAC. VBAC should take place in a hospital.

See also: Medical reasons for a c-section, Inducing labor, Stages of labor

Last reviewed March 2020

Vaginal Birth After A C-Section (VBAC): Benefits & Risks

Written by WebMD Editorial Contributors

If you’re pregnant again and your last baby arrived via cesarean section, you may wonder if a vaginal birth could be an option for you this time around. A vaginal birth after C-section (VBAC) is possible for many women, but there are factors to help you and your doctor decide if it’s right for you.

Safety for you and your baby is the main thing to consider. VBAC isn’t always safe for every woman.

If you try to have a vaginal birth and you’re at high risk of complications, it can cause serious problems for you and your baby — some even life-threatening. That’s why it’s important that you talk to your doctor about the risks.

For you and your doctor to consider a vaginal birth for you, both you and your baby need to be in good health. You might even be able to attempt VBAC if you’re pregnant with twins if your doctor says that all of you are healthy enough.

Your doctor may suggest that VBAC is too risky for you to succeed at vaginal birth. Risks could include any of the following:

• Obesity (your body mass index is 30 or higher)
• Preeclampsia (high blood pressure during pregnancy)
• Age (usually older than 35)
• Your previous cesarean was in the last 19 months
• The fetus is very large

One crucial detail that you and your doctor must discuss is the type of C-section scar that you have on your uterus. (This may be the same type of scar that you have on your abdomen, but it may go in a different direction.) Doctors make incisions (cuts in the abdomen and uterus) in two different directions during a C-section:

• A vertical cut goes from top to bottom
• A transverse cut goes from side to side

If your C-section scar is vertical, you cannot attempt VBAC. There is a very high risk that your scar could rupture (burst open or tear) when you try to have a vaginal birth, which could cause great harm to you and your baby. You’ll need to have a C-section again.

If your C-section scar is low and transverse, your doctor might allow you to try VBAC, if your other risk factors are low.

Check with your doctor early to find out if the hospital you’re using allows women to attempt VBAC. Not every hospital does.

Although the risk of your old scar rupturing during VBAC is low, the hospital must be prepared to handle the emergency that could arise if it does. Some hospitals simply aren’t prepared to handle it.

There is a very small chance for every woman who attempts VBAC that their uterus could rupture, even if they have a low transverse C-section scar and is in good health. Doctors can’t be 100% certain whether or not it may happen to you.

Even though ruptures happen in less than 1% of VBAC attempts, some women don’t want to try it at all, because if it does occur, it can be very dangerous. You need to weigh your options and talk to your doctor before you decide what to do.

If VBAC is an option for you and you like the idea of trying a vaginal birth, there are many reasons you might want to give it a shot. There’s a good chance that you may succeed: About 70% of women who try are able to have their babies via vaginal birth. For the rest, a C-section is needed, due to problems that arise during the attempt.

You may want to attempt VBAC for many reasons because if it is successful, it has the following benefits:

• Doesn’t require surgery
• Less blood loss
• Faster recovery
• Reduced chance of infection
• You are not likely to suffer injury to your bladder or bowel
• You will be likely to have fewer problems with future childbirth

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Natural birth or caesarean section?

16/03/2018 – 13:35

Expectant mothers often face a dilemma: what will be better for her and the baby – natural childbirth or caesarean section. Both methods of obstetrics have their pros and cons, their indications and contraindications.

Aleksey Sherstobitov, head of the obstetric department of the Chelyabinsk Regional Perinatal Center, obstetrician-gynecologist of the highest category, helped the Ural-press-inform agency to dispel the fears and unnecessary fears of women.

– Alexey Vasilyevich, in your opinion, as a professional, what choice should I make (natural birth or caesarean section), based on the benefits for mother and child?

– Until about the 1980s, the percentage of caesarean sections was about 2-4 percent of the total volume of deliveries. And we are all alive and well. And everything is fine with our grandmothers and mothers.

– What are the advantages of natural childbirth?

– In case of childbirth through natural birth canal, there is no pain syndrome in the postoperative period. The recovery process for the female body as a result of natural childbirth is much faster than after a cesarean section. There are fewer complications. Accordingly, the time of stay of a woman in labor in a hospital is reduced. The woman goes home on the third or fourth day. After caesarean section – only for 4-5 days. In addition, during natural childbirth, the baby is immediately brought to the mother’s breast, which is good for the health of the newborn and for the mother’s lactation.

– When is natural childbirth contraindicated?

– For certain medical conditions in a woman (eg, somatic, eye, cardiovascular disease), vaginal delivery is more of a risk than a benefit. For some women, a caesarean section is performed according to indications that occur during childbirth (acute fetal hypoxia and others). There are also relative indications – breech or foot presentation, large fetus.

– Is the woman’s age an indication for caesarean section?

– Now women are increasingly giving birth at a late reproductive age. Previously, a woman aged 33 years and older was written late. And that was an indication for a caesarean section. Now there is no such term, and women at this age also give birth through the natural birth canal. We have several women who are 44-47 years old sometimes pass through us in a week.

– How old was your oldest woman in labor?

– 51 years old (her first daughter was already 31 years old). There was also a woman who had her first pregnancy at the age of 49.

– Can a woman in labor be an indication for a caesarean section?

– There are several countries in the world where the indication of a woman’s desire to have a caesarean section is legislated. The Russian Federation is not included in this list of countries. Therefore, we do not perform cesarean at the request of a woman without medical indications. Indications for a caesarean section are clearly regulated by the order of the Ministry of Health of the Russian Federation. They are divided into a number of groups: planned and emergency indications during pregnancy, as well as emergency during childbirth. And there is no such indication as the desire of a woman.

– The number of births by caesarean section has increased dramatically. Why did this happen?

– Perinatal focus of medicine has expanded the range of indications for operative delivery. For example, earlier women with heart defects were strictly forbidden to give birth. At the moment, these defects are being corrected. For a woman, therapy is selected, and she becomes pregnant. Subject to certain rules, a favorable outcome is guaranteed. The method of delivery is chosen in each case individually, depending on the degree of compensation of the defect by the time of delivery.

– Have caesarean sections become more advanced today?

– Yes. The technique of performing caesarean section operations is being improved, more modern suture material is used, when sutured, the lower uterine segment is better restored, less scar tissue is formed.

– Previously, if a woman had a caesarean section during her first birth, then only a caesarean section during her second and subsequent births . ..

– Absolutely right. But for the fourth year in our perinatal center, women with a scar on the uterus give birth through the natural birth canal.

– And now, after the first caesarean, a woman, having become pregnant for the second time, can choose – to give birth through the birth canal or she will have a caesarean section?

– Yes. If a woman with a scar on the uterus wants to give birth through the birth canal, she must sign up for a planned hospitalization with us. She will need to submit the protocol of the previous operation – a caesarean section. We will see how it was performed, we will find out from the woman if there were any complications in the postoperative period. Doctors working in the ultrasound department will assess the condition of the lower uterine segment, the obstetrician – the viability of the scar.

Then the woman in labor enters the department of pathology of pregnant women, where a consultation is held with the participation of the chief physician, the head of the department, and employees of the department of the Chelyabinsk State Medical Academy. And we determine whether a woman can give birth through the natural birth canal or not.

– Does a pregnant woman with a scar on the uterus need early hospitalization in a maternity hospital?

– Each time the issue is resolved individually. It depends on many factors: parity (what kind of child a woman should give birth to), how far she lives from the perinatal center. Residents of remote areas, we try to hospitalize in advance. For women living in Chelyabinsk or at a distance of 30-40 kilometers from the regional center, there are no indications for early hospitalization.

– Only residents of the region or Chelyabinsk can apply to the regional maternity hospital?

– A woman, regardless of where she lives, can choose the maternity hospital where she wants to give birth. But for this, she must come to the maternity hospital in advance, sign a dispensary book, and discuss the terms of hospitalization.

Normal delivery? C-section?

Should women opt for normal delivery or caesarean section?

Normal delivery if there are no obstacles to normal delivery.

Is normal delivery better than caesarean section?

There is a misconception: a normal birth is good for the mother, a caesarean is good for the baby… This is unacceptable. In some cases, normal delivery is very harmful to the mother and a caesarean section is required. But if conditions are good, of course normal delivery is good for the mother. With normal childbirth, the mother’s recovery process is much faster. Since there is no need to enter the abdominal cavity, some associated complications do not occur. The hospital stay is short. The mother leaves the hospital faster and returns to her usual work and normal life faster. For the baby, if everything goes well, there will be no problems with a normal birth. A caesarean section should only be done if necessary.

What are the advantages and disadvantages of normal delivery?

The advantages of a normal birth are that it is a normal process, everything ends as soon as the birth is over, the complication rate is very low, labor pains can be removed with an epidural, the mother’s recovery process is much faster, the hospital stay is shorter, the mother returns to normal life faster . The sagging of the organ, which can be considered a disadvantage, is only about one to two percent and can be eliminated by a much simpler operation compared to a caesarean section.

What are the advantages and disadvantages of a caesarean section?

Disadvantages of caesarean section are that it requires surgery, there is little risk of infection and bleeding, maternal blood transfusion may be required due to bleeding, pain lasts longer compared to childbirth, wound healing takes a long time, removal of gases is a problem, and the mother needs a week to get back to normal. Its advantage is that it can save the life of mother and child in some cases where normal delivery is not possible.

What factors prevent a woman from giving birth normally?

The reasons preventing a normal birth may depend on the mother or the child. We can enumerate those that depend on the child as follows: inverted child position, breech presentation or lying on the side. During labor pains, the baby’s heart sounds are disturbed, the baby shows signs of oxygen starvation, the baby is too big and cannot pass through the mother’s birth canal. Maternal factors are as follows: mothers with deformity due to congenital hip dislocation, mothers with active herpes infection, and women with diseases such as AIDS. There are also obstacles that belong to the mother and the child, such as placing the placenta at the exit site of the child, that is, creating an obstacle for the exit of the child. In a mother who does not have any of these conditions and whose pregnancy was perfectly normal; If the baby is not too large and the mother’s birth canal is adequate, normal delivery will not cause harm.

How did normal delivery and caesarean section affect the woman in the postpartum period?

Of course, normal childbirth is more comfortable in terms of postpartum pain. Because as soon as the birth is over, almost everything is over. With a caesarean section, the healing process of the wound site occurs. There are problems with gas formation, which can last for several days. Of course, it must be said that today, especially the operating room and anesthesia conditions are improved compared to the past, which makes patients much more comfortable with caesarean sections.