Some people who give birth by cesarean birth worry about whether or not they’ll be able to give birth vaginally down the road. The truth is, while many who have had cesarean birth do go on to have more of them, many others go on to have healthy, safe vaginal deliveries in the future. There is a good chance you will have a vaginal birth after a cesarean birth, depending on the reasons for previous cesarean birth.
About 90% of women who have had cesarean birth are good candidates for labor after cesarean birth. A successful vaginal birth following a cesarean birth is known as a VBAC (vaginal birth after cesarean). Depending on which study you look at and, often, the hospital where you’re planning to give birth, VBAC rates are around 60 to 80%.
In short, not only can you have a vaginal delivery after a cesarean birth, but it’s often a good choice to do so.
Why choose VBAC?
The main reason for a VBAC can be a positive outcome for moms who have had a previous cesarean birth. Some may not desire another major abdominal surgery. Cesarean births can lead to longer hospital stays, longer recovery times, and the risk that always comes with anesthesia.
Additionally, those who plan to have future pregnancies may choose VBAC if possible, because repeated deliveries by cesarean birth can cause risks like an increased chance of injuries to the bowel and bladder, and placenta accreta in a subsequent delivery.
Finally, many want vaginal deliveries for personal reasons, and can find the experience of a VBAC more satisfying. Having a friend, partner, doula, midwife, or other support person present through a VBAC can help you get the most out of the experience, while also cutting down on stress.
What makes somebody a good candidate for a VBAC?
Many people are good candidates for VBAC, particularly those whose pregnancies have the following characteristics:
- No history of uterine surgery other than previous cesarean birth
- Have not experienced uterine rupture or extensive uterine surgery like fibroid removal
- No more than 1 or 2 previous cesarean births
- A low, horizontal (transverse) incision (on the uterus, not skin) was used in the previous cesarean birth
- No recurrence of the medical reason that led to the previous cesarean birth in this pregnancy
- No contraindications to a vaginal birth
- Planning to give birth somewhere with 24-hour access to an emergency cesarean birth if needed
Who might a VBAC not be right for?
Depending on the hospital, those who have had more than two cesarean births may not be considered good candidates for VBACs, as well as those who:
- Had a prior cesarean birth incision that was vertical (or “classical”) instead of low and horizontal (transverse) along the abdomen
- Have experienced a prior uterine rupture, which increases the chances of uterine rupture in the future
- Have pregnancies past their due date
- Carry unusually large babies
- Carry multiples
Your prenatal provider will take all of your risk factors into account before determining whether a VBAC might be right for you.
What are the risks of a VBAC?
The most common risk is a repeat cesarean birth, which comes with all of the risks of major surgery, plus an increased risk of further complications during delivery for future pregnancies. In some rare cases, though, there is also a chance of uterine rupture, when the area around the incision scar from the previous cesarean birth starts to thin under stress, and eventually tear. In the case of a uterine rupture, an immediate emergency cesarean birth would be needed to prevent potentially life-threatening health concerns.
Other risks include blood loss, infection, and damage to surrounding organs.
If you think you might be interested in a VBAC, it’s a good idea to discuss it with your healthcare provider ahead of time. Your provider will be able to tell you if you’re a candidate, and since healthcare providers have different levels of comfort assisting in VBACs, you’ll be able to assess whether your provider, or the hospital they deliver at, is a good fit for your birth goals.
Reviewed by the Ovia Health Clinical Team
Sources
- Mayo Clinic Staff. “Vaginal birth after C-section: Risks.” Mayo Clinic. Mayo Clinic, June 12 2015. Web.
- Sally C. Curtin, et al. “Maternal Morbidity for Vaginal and Cesarean Deliveries, According to Previous Cesarean History: New Data from the Birth Certificate, 2013.” National Vital Statistics Report. Center for Disease Control. Web. May 20 2105.
- Robert M. Silver, et al. “Maternal Morbidity Associated with Repeat Cesarean Deliveries.” Obstetrics & Gynecology. 10.1097/01.AOG.0000219750.79480.84. Web. June 2006.
- Committee on Obstetric Practice. “Committee Opinion: Placenta Accreta.” American College of Obstetricians and Gynecologists. Web. July 2012, reaffirmed 2015.
- Cynthia S. Shellhaas, et al. “The Frequency and Complication Rates of Hysterectomy Accompanying Cesarean Delivery.” Obstet Gynecol. 10.1097/AOG.0b013e3181ad9442. Web. August 2009.
- “Vaginal birth after cesarian.” MarchofDimes. March of Dimes. August 2015. Web.
