If you had a baby by cesarean (C-section) and you’re pregnant or thinking about growing your family, you may have questions about your childbirth options. Is another C-section the best choice? Or do you want to attempt a vaginal birth after cesarean (VBAC)?
Kathleen Curley, MD, an OBGYN with Banner - University Medicine, outlined some of the benefits, risks and factors to consider. She explained that what we commonly call VBAC is more accurately called trial of labor after cesarean delivery (TOLAC).
That’s because if you try for a vaginal birth, you won’t know if it’s successful until after your baby is born. You could prepare for a vaginal birth but discover that you need a C-section as your pregnancy continues or when you’re in labor.
Here’s some important information to factor in as you make decisions about your delivery.
Benefits of VBAC
The top advantages of having a vaginal birth after cesarean are:
A faster recovery
Most people recover from VBAC more quickly than from cesarean births, without the risks associated with surgery. “People who have vaginal deliveries also typically have a shorter stay in the hospital, which may be desirable for those who have young children at home,” Dr. Curley said.
With a VBAC, you’ll probably be able to move around more easily, have less pain and return to your normal activities faster than you would after major surgery.
Fewer complications
All surgeries come with risks. A VBAC has less risk of infections, blood clots, excessive bleeding, complications from anesthesia and injury to organs from cutting through the abdomen and uterus.
Multiple C-sections may put you at higher risk for placenta problems in future pregnancies. With VBAC, you’re at lower risk for the placenta covering the cervix (placenta previa) or the placenta growing too deeply into the uterine wall (placenta accreta). These conditions can cause serious bleeding and you may need surgery to treat them.
An experience that aligns with your preferences
You may strongly desire a VBAC, which may give you a greater sense of control and a stronger emotional connection during the delivery process.
Risks of trying VBAC
While there are a lot of benefits to attempting a vaginal birth, there are risks you should be aware of as well.
Uterine rupture
The biggest risk is if the scar on the uterus from the previous C-section opens during labor (uterine rupture). The risk is low — between 0.7% to 2%. “But it requires emergency cesarean delivery,” Dr. Curley said. “A uterine rupture can lead to significant bleeding, possible removal of the uterus and brain damage or death to the baby.”
The risk of uterine rupture is higher if you had a vertical or T-shaped incision with a previous C-section, which you may have needed if your baby was very preterm. The risk is also higher if you have had more than one C-section in the past, have labor induced or space your births close together.
To lower this VBAC risk, your health care team will monitor the baby’s heart rate closely when you are in labor. “Because of the risk of uterine rupture, we do not recommend a trial of labor after cesarean at a birth center or at home,” Dr. Curley said.
Success rates and what improves your odds
“We know that a vaginal delivery is the safest delivery route for both the pregnant patient and their baby,” Dr. Curley said. “However, a cesarean delivery during labor is riskier than a planned C-section. Given this, we encourage people to consider attempting vaginal delivery if they have a high chance of success.”
“The overall success rate is about 70% and most people are candidates,” Dr. Curley said. It can improve your odds of VBAC if you:
- Have had a vaginal delivery in the past.
- Have only had one C-section and no other major surgeries on the uterus.
- Had a low, horizontal C-section incision.
- Had a cesarean delivery for a reason that may not happen again, like if the baby was breech or there were problems with the baby’s heart rate.
- Come to the hospital in spontaneous labor, as opposed to being induced.
- Have a normal body mass index (BMI)
- Haven’t had a uterine rupture in the past (if you have, you’re not a candidate for attempting VBAC).
- Wait at least 18 months after your C-section to get pregnant.
- Have a generally healthy pregnancy.
“We strongly encourage people who want to have lots of children to consider attempting a vaginal birth, because we know that each cesarean delivery is riskier to both the patient and their baby,” Dr. Curley said.
On the other hand, if you feel your family is complete, you may want a scheduled C-section. “That’s because if you want a tubal ligation, we can perform that at your cesarean delivery,” she said.
When you’re making your decision, you’ll want to have a detailed conversation with your health care provider. Your personal health and your medical history play a role in making the right choice.
Ask about the type of incision you had before, your personal risk of complications and any concerns you have. Health issues like obesity, high blood pressure or diabetes may factor into the decision.
“Your physician will know your history and situation best. You should feel comfortable discussing this with your provider and you should feel heard regarding your preferences for delivery,” Dr. Curley said.
Preparing to attempt a vaginal birth after C-section
When you’re going to try to have a VBAC, you’ll want to have a flexible birth plan that accounts for the possibility of an unplanned C-section. In your birth plan:
- Outline your preferences for labor, such as pain relief options, your ability to move around and your labor support team.
- Consider what you would want in the event of an unplanned C-section, such as having a support person staying with you or having immediate skin-to-skin contact with your baby.
- Remember that labor can be unpredictable. Planning is important, but the goal is a healthy delivery for you and your baby.
To prepare:
- Choose a medical facility that has experience in these types of deliveries and a team that supports your attempt at VBAC. “In this situation, we do not recommend using a birth center or attempting to deliver at home,” Dr. Curley said.
- Stay active with low-impact exercises like walking or prenatal yoga. Strength and stamina can help improve your chances of a successful VBAC.
- To manage any strong emotions, try mindfulness practices or talk to a counselor.
- Consider having a partner, doula or midwife to guide you through labor. Having the right support can make a big difference.
The bottom line
If you’ve delivered a baby by C-section, you may want to try a vaginal birth after cesarean (VBAC) in a future pregnancy and delivery. Many people can have a successful vaginal delivery after a C-section, but there are many factors to consider.
If you’re deciding whether attempting a vaginal delivery might be right for you and your family, reach out to an OBGYN at Banner Health for expert advice.
