A vaginal birth after a cesarean section (VBAC) is when a person gives birth vaginally after previously having a surgical birth. Although a VBAC is similar to any other vaginal birth, it may require more monitoring.

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Having a vaginal delivery reduces the risk of several complications, including infection and excessive bleeding. Vaginal deliveries also tend to have shorter recovery times.

Cesarean delivery, or cesarean sections (C-sections), are generally very safe, but they leave individuals slightly more vulnerable to complications.

Some people who have had a C-section in the past choose to have a vaginal delivery for future pregnancies. These deliveries, called a VBAC, carry a higher risk of uterine rupture. But the absolute risk of this complication is low.

To avoid this risk, some doctors may not feel comfortable caring for someone who is having a VBAC. Most people who have a VBAC are successful, but some who desire a VBAC have trouble finding a doctor or hospital that will permit one. They also often report feeling pressured, or even forced, to have C-sections.

Vaginal birth after cesarean (VBAC) is any vaginal delivery after a past surgical birth. It is not a surgical or medical procedure, since vaginal delivery is the typical course of birth without interference.

But a VBAC may require certain medical interventions. People who have a VBAC may need additional monitoring or access to a team that can perform an emergency C-section.

Many people who have had C-sections in the past would automatically have a C-section for any future deliveries. Despite this, VBACs can be a safe and preferable option for many individuals.

A VBAC is similar to any other vaginal birth. First, a person will experience increasingly painful contractions, followed by an urge to push.

If labor progresses typically, most people are able to continue with a vaginal delivery. But if there are birth complications, a doctor may recommend a C-section.

Before the birth, a doctor may recommend an ultrasound to determine the position of the baby. Additionally, some may recommend birth interventions. These may include:

  • Epidural: An epidural numbs the body from the waist down. Having an epidural may make it easier to get an emergency C-section, since the birthing person is already numb.
  • Continuous fetal monitoring: This helps doctors monitor the baby, and may help them detect signs of fetal distress or problems with the uterus.
  • More monitoring of the mother: A healthcare professional may recommend more frequent vaginal exams, ongoing monitoring of blood pressure, or that a doctor, not a midwife, attend the birth.
  • Access to an emergency care team: Many healthcare professionals will only attend a VBAC in a hospital that has the capacity to perform an immediate emergency C-section.

A birthing person may decline these interventions if they desire.

But ignoring medical recommendations may increase the risk of complications and cause conflict with a care team. It may be beneficial to discuss possible interventions with a doctor before a person’s due date.

For most people, a VBAC is the same as a typical vaginal delivery. But VBACs do carry higher risks of certain complications.

Some of these include:

  • Emergency surgery: If a VBAC does not go to plan, or a person experiences a uterine rupture, they may need an emergency C-section. This has a higher risk of other complications.
  • Uterine rupture: A uterine rupture is a dangerous birth complication that happens when the uterus tears. Although the risk is less than 1% for people with one past C-section, it is slightly higher for those who have had multiple past C-sections. It can be fatal, but the overall risk of death is low.
  • Fewer delivery options: A doctor may place constraints on VBACs. Some people have difficulty finding a doctor who will perform one, especially if they have had several C-sections.
  • Uncertainty: If a VBAC does not go to plan, an individual may need to change their birth plan suddenly. A person who plans an elective C-section has more certainty about their birth experience.

Many people prefer the experience of vaginal birth, and others are eager to avoid potentially unnecessary surgery. All reasons for wanting a VBAC are valid, and people preparing to give birth should feel empowered to make the right decision for them and their family.

In addition to a person’s preference, there are several benefits to a VBAC, including:

  • Lower risk of surgical complications: Surgical birth increases the risk of excess bleeding and infection. A person may also have complications from anesthesia.
  • Faster recovery: Recovering from a vaginal birth typically takes less time. A person usually requires a shorter hospital stay with a VBAC.
  • Improved mental health: Surgery can be scary, and some research suggests that surgical birth is a risk factor of postpartum depression and other mental health challenges. For example, a 2019 meta-analysis found an association between C-sections and postpartum depression. But it should be noted that a C-section is just one of many risk factors of postpartum depression.
  • Parental choice: Some birthing parents may prefer, or desire, the experience of a vaginal birth. Those who have had a past traumatic C-section may fear having another.
  • Maternal health concerns: Despite its risks, VBAC correlates with an overall decrease in birth complications.

Not all people who have had C-sections are able to have a future vaginal birth. People may want to discuss their eligibility with a doctor when creating a birth plan.

A 2019 meta-analysis assessed past studies on successful VBACs. It found that the following factors increase a person’s chances of a successful vaginal delivery:

  • Reason for C-section: When a past C-section happened because of the fetus’ position rather than a serious health complication, the odds of success with a VBAC increase.
  • Bishop score: This is a measure of how ready the body is for labor. It looks at factors such as how soft the cervix is and how low the baby is in the pelvis. A higher bishop score correlates with a higher chance of success, which may be because the person is more likely to go into labor naturally. Some doctors do not want to induce a VBAC as it increases the risk of uterine rupture.
  • White race: According to research, white people are more likely to have successful VBACs. But this does not mean that being white affects the physiology of pregnancy or VBACs. Numerous studies have documented ongoing racism in maternity care, and Black birthing people may receive different care that increases their risk of a C-section.

Certain factors may make vaginal delivery an unsafe option. If an individual previously had a C-section because of an unchanged condition, such as cephalo-pelvic disproportion (the baby being unable to pass through the pelvis), they will likely need another C-section.

People who had a past C-section because of a changeable factor, such as the fetus being breech (facing feet-down instead of head-down), may be more likely to have a successful VBAC.

Some individuals are not good candidates for a VBAC. The following factors increased the risk of needing another C-section:

  • Older maternal age: This means that the birthing person is over the age of 35 years.
  • Macrosomia: This means that the fetus’ head is unusually large. Doctors usually define this as a fetus who weighs more than 4 to 4.5 kilograms (kg).
  • Labor induction: Inducing labor decreases the odds of success.
  • Pregnancy complications: Diabetes and high blood pressure correlate with a lower risk of success.
  • Obesity: Obesity correlates with a higher chance of another surgical birth.
  • Shoulder dystocia: A past history of shoulder dystocia, which happens when the baby’s shoulders get stuck during birth, lowers the odds of VBAC success.

Some factors increase the risk of uterine rupture and other complications. They include:

  • Classical C-section scar: This means that there is a vertical incision higher in the abdomen rather than a horizontal one lower in the abdomen.
  • Multiple past C-sections: The risk of uterine rupture increases with each C-section.
  • Other uterine surgeries: Having multiple uterine surgeries may increase the risks inherent to a VBAC.

People considering having a VBAC should try finding a doctor who supports VBACs. They may also find it helpful to talk with other people who have had VBACs, or to connect with an organization such as the International Cesarean Awareness Network.

They can discuss risk factors, medical history, and concerns with a doctor in advance. Together, they can create a birth plan that includes a person’s desired VBAC while reducing the risk of complications.

A VBAC can be a welcome experience after a C-section, especially for people who prefer vaginal delivery or did not enjoy their past C-section experience.

For many people, VBAC can be a safe and successful delivery option. Individual factors, such as age, past mode of delivery, and Bishop score, can affect a person’s chances of VBAC-related complications.

People considering a VBAC should contact a doctor to discuss relevant risk factors and develop a safe and supportive birth plan.