If you've delivered a baby by C-section and you're pregnant again, you might be able to choose between scheduling a repeat C-section or a vaginal birth after cesarean (VBAC).
For many women, VBAC is an option. In fact, research on women who attempt a trial of labor after cesarean (TOLAC) shows that about 60 to 80 percent have a successful vaginal delivery.
VBAC isn't right for everyone, though. Certain factors, such as a high-risk uterine scar, can lower your likelihood of VBAC and make the option inappropriate. Some hospitals don't offer VBAC because they don't have the staff or resources to handle emergency C-sections. If you're considering VBAC, your health care provider can help you understand if you're a candidate and what's involved.
Women consider VBAC for various reasons, including:
You might be a candidate for VBAC if you are:
You're not a candidate for VBAC if you have had:
Some health care providers won't offer VBAC if you've had more than two prior C-sections. VBAC also generally isn't an option if you are pregnant with triplets or higher order multiples.
Factors that decrease the likelihood of VBAC include:
While VBAC is associated with fewer complications than an elective repeat C-section, a failed trial of labor after cesarean (failed TOLAC) is associated with more complications, including, rarely, a uterine rupture. If your uterus tears open during labor, an emergency C-section is needed to prevent life-threatening complications, such as heavy bleeding for the mother. If the rupture is complex or to stop the bleeding, the uterus might need to be removed (hysterectomy). If your uterus is removed, you won't be able to get pregnant again.
If you've previously had a C-section and you're pregnant, you might begin talking about VBAC at your first prenatal visit. Discuss your concerns and expectations with your health care provider. Make sure he or she has your complete medical history, including records of your previous C-section and any other uterine procedures. Your health care provider might use your medical history to calculate the likelihood that you'll have a successful VBAC. It's important to continue discussing the risks and benefits of VBAC throughout pregnancy, especially if certain risk factors arise.
If you choose a VBAC, boost your odds of a positive experience:
If you choose VBAC, when you go into labor you'll follow the same process that's used for any vaginal delivery. Your health care provider will likely recommend continuous monitoring of your baby's heart rate and be prepared to do a repeat C-section if needed.