Vaginal Birth After Cesarean (VBAC)
What is a vaginal birth after cesarean delivery? — A vaginal birth after cesarean delivery is when a woman gives birth to a baby through her vagina after she had a baby by c-section in the past. A c-section, also called a "cesarean delivery," is surgery to get a baby out of a woman's uterus. A vaginal birth after cesarean delivery is called a "VBAC" for short.
Years ago, doctors thought that after a woman had one c-section, she had to deliver all her other babies by c-section. That's because the uterus is cut open during a c-section. Even though the cut is stitched up and heals, doctors worried that the original cut could open up again when the woman went into labor. Doctors now know that this rarely happens. Many women can safely have a vaginal delivery after a c-section.
These days, a woman who had a c-section in the past usually has a choice about how she will deliver her other babies. She can either:
●Try to go through labor and have a vaginal delivery – Doctors call this a trial of labor after cesarean, called "TOLAC" for short. A trial of labor might work and end with a VBAC. But sometimes it doesn't work, and the woman needs another c-section to deliver her baby.
●Plan to have another c-section before labor starts
What are the benefits of a VBAC? — The benefits of a VBAC include:
●A shorter stay in the hospital after giving birth
●Less pain and a shorter recovery time (usually)
●Fewer problems after the delivery – Women who have a c-section have a higher chance of getting a fever, infection, blood clot in the legs, or needing blood.
What problems might happen with a trial of labor? — Different problems can happen with a trial of labor. But the problem doctors and midwives worry about most is the uterus tearing. This is an emergency. The mother and baby can be harmed if this happens. If it happens, a c-section needs to be done right away to deliver the baby and fix the tear. The risk of the uterus tearing after one cesarean is <1%.
Sometimes a trial of labor doesn't work. The labor might not progress normally and the baby might need to be delivered by c-section anyway. This can be upsetting and stressful for a woman.
What if I want to try and have a VBAC? — If you want to try and have a VBAC, let your doctor know. Based on your individual situation, he or she will help you decide whether a trial of labor is a good choice for you.
In general, a trial of labor has the highest chance of working when:
●A woman had a vaginal delivery in the past (in addition to having a c-section).
●The first c-section was done because the baby was in a breech position. A breech position is when a baby's legs or buttocks (and not head) are closest to the vagina.
For some women, a trial of labor is not recommended. This happens when:
●The uterus was not cut open in the usual way during the previous c-section.
●The woman had many c-sections.
●A vaginal birth isn't safe for the mother or baby.
Plus, your doctor will only let you have a trial of labor in a hospital or center where a c-section could be done right away if needed.
Content adapted from UpToDate Patient Information.