Introduction
Historically, the phrase “once a cesarean, always a cesarean” ruled the day. However, many women who have had a prior C-section can safely deliver vaginally in subsequent pregnancies. Called VBAC (Vaginal Birth After Cesarean), this approach can offer numerous advantages, like quicker recovery and lower surgical risks.
Still, VBAC comes with considerations that must be weighed carefully—particularly the rare but serious risk of uterine rupture. This article discusses the pros and cons of VBAC, candidate suitability, and what to expect if you choose to pursue one.
What Is VBAC?
VBAC refers to giving birth vaginally after you’ve previously had a C-section. Though not all women are candidates, many find that VBAC aligns with their desire for less medical intervention and a more immediate postpartum recovery. An alternative option is a repeat cesarean delivery (also called ERC—elective repeat cesarean), which may be preferred or recommended in certain scenarios.
Benefits of a VBAC
Shorter Recovery and Hospital Stay
Vaginal births typically involve less postoperative pain and allow most mothers to resume normal activities—like caring for older children—sooner than after abdominal surgery.
Reduced Surgical Complications
Surgery-related issues such as infection, hemorrhage, or organ injury are less frequent in vaginal deliveries than in repeat C-sections. This can lower the likelihood of certain long-term complications like scar tissue or placenta problems in future pregnancies.
Emotional and Psychological Advantages
Some women desire the experience of labor and spontaneous birth. VBAC can provide a sense of autonomy or closure if a prior C-section felt unexpected or distressing.
Potential Risks and Considerations
Uterine Rupture
Although rare (less than 1% in many studies), uterine rupture happens when the cesarean scar on the uterus tears during contractions. This complication can endanger both mother and baby, often requiring an emergency C-section.
Emergency C-Section
Even after attempting VBAC, some women need an urgent surgical delivery if labor stalls, fetal distress develops, or complications arise.
Less Predictability
Unlike a scheduled repeat C-section, VBAC entails watching for signs of labor. This can add unpredictability to scheduling and mental preparation.
Determining VBAC Candidacy
Individual Factors
Whether you’re eligible for VBAC largely depends on the details of your obstetric history:
- Type of Uterine Incision: Low transverse cuts (the most common) are safer for VBAC than classical or “T” incisions.
- Number of Prior C-Sections: While multiple prior cesareans don’t always rule out VBAC, more scars may slightly increase risk.
- Reason for Prior Cesarean: If it was for a non-recurrent issue (like a breech presentation), VBAC success odds are higher compared to a prior cesarean for cephalopelvic disproportion or a narrow pelvis.
Guidelines from Professional Bodies
Organizations like the American College of Obstetricians and Gynecologists (ACOG) encourage offering a VBAC attempt (TOLAC: trial of labor after cesarean) to most women with low-transverse incisions unless there are clear contraindications.
Institutional and Practitioner Factors
Some hospitals offer “VBAC-friendly” policies, including on-site anesthesia or operating rooms for rapid response. Clinicians must also be comfortable managing VBAC and evaluating each woman’s risk.
How to Prepare for a VBAC
Talk to a Supportive Healthcare Team
Seek providers who have experience with VBACs. They’ll review your prior delivery records, evaluate your scar type, and discuss your potential success rates based on medical history.
Stay Healthy Throughout Pregnancy
Controlling weight gain, managing any chronic conditions (like diabetes or hypertension), and taking prenatal vitamins all bolster your general well-being and reduce complications in labor.
Learn about Labor Expectations
Understand typical labor stages, pain management options, and how your progress is monitored more closely for signs of uterine stress or fetal distress.
Develop a Birth Plan—but Stay Flexible
Drafting a birth plan for VBAC is helpful, but remain open to adjustments if complications arise. The ultimate goal is a healthy outcome for both mother and baby, whether that means a vaginal or repeat cesarean birth.
During Labor: What to Expect
Continuous Monitoring
Given the risk of uterine rupture, healthcare providers usually monitor fetal heart rate patterns and maternal status closely. External fetal monitors or occasional internal monitors might be used.
Pain Relief Choices
You can consider epidurals or other analgesics. Some providers prefer epidurals because they can reduce potential stress on the scar, but it remains a personal choice. Confirm with your labor team for guidelines on early vs. delayed epidural placement.
Signs of Potential Complications
Be aware of strong uterine pain that differs from normal contractions, abnormal fetal heart rate patterns, or slowed labor progress, all of which may prompt switching to a C-section.
Postpartum Recovery
If VBAC Is Successful
Expect standard vaginal birth recovery—soreness, possible perineal tears, postpartum bleeding (lochia), and the usual emotional highs and lows. But it typically involves less pain and a faster healing timeline than post-cesarean healing.
If Another C-Section Happens
While it may feel disappointing if you hoped for a VBAC, it’s crucial to remember that maternal and fetal safety took priority. Recovery will be similar to your previous C-section experience, though each surgery is unique.
Emotional Support
Whether VBAC or repeat C-section, postpartum can bring on intense emotions. Seek out family help, mental health resources, or postpartum support groups if you’re grappling with birth outcome feelings or stress.
Conclusion
VBAC offers many women an alternative to repeat cesarean, with advantages like quicker recovery and fewer complications linked to multiple surgeries. While uterine rupture is a rare but serious risk, careful selection of eligible candidates and close labor monitoring help many women achieve successful VBACs. If you’re considering trying for a vaginal delivery after a C-section, discuss your obstetric history, personal preferences, and concerns with a supportive provider. By staying informed, proactive, and flexible, you can navigate the path to a safe and fulfilling birth experience.
References
- American College of Obstetricians and Gynecologists (ACOG). Practice Bulletin No. 115: Vaginal birth after previous cesarean delivery. Obstet Gynecol. 2019;133(2): e110–e127.
- Society of Maternal-Fetal Medicine (SMFM). Guidelines for the management of TOLAC. 2020.
- Guise JM, Denman MA, Emeis C, et al. Vaginal birth after cesarean: new insights on maternal and neonatal outcomes. Obstet Gynecol. 2016;127(3):685–694.
- Marshall NE, Fu R, Guise JM. Impact of multiple prior cesarean deliveries on maternal morbidity: a systematic review. Am J Obstet Gynecol. 2018;214(5):572.e1–572.e10.
- Landon MB, et al. What is the optimal trial of labor after cesarean policy? Clin Obstet Gynecol. 2020;63(3):506–517.
