Is a vaginal birth after C-section (VBAC) right for you?

Linda Balles, CNM

Obstetrics and Gynecology

If you’ve had a prior C-section, you might believe you will always have to have C-sections for future pregnancies. This simply isn’t true.

“VBAC is a safe choice for most people who have had a C-section,” Linda Balles, certified nurse midwife, said. “Different individuals might have different reasons for each option, and what matters is that you and the baby are healthy and happy.”

She explained what to know if you’re considering a vaginal birth after cesarean delivery.

Why would someone choose a VBAC?

For many, the wish to avoid major abdominal surgery may be a driving factor in wanting a VBAC, while others may find that they are drawn to the opportunity to experience vaginal birth directly.

While a vaginal birth after C-section does carry risks, so does having a repeat C-section.

What are the risks of VBAC?

There is a risk that the cesarean scar on the uterus may rupture, or open. This can be life threatening and an emergency surgery would be required.

“The risk of uterine rupture is rare around .05%,” Balles said. “In other words, one uterine rupture might happen for every 200 people who plan to have a VBAC.”

Even if a uterine rupture does occur, both mom and baby will often recover fully afterward. In some cases, though, complications may arise including excessive bleeding, the need to remove the uterus, or the possibility of injury to the baby.

The risk of a uterine rupture increases if the next baby is born within two years after the prior C-section, or if certain medications are used to induce or augment labor.

What are the risks of repeat C-sections?

The risks associated with repeated C-sections mirror those of any major abdominal surgery. These include:

• Fever
• Infection
• Bowel or bladder injury
• Blood clots
• In future pregnancies, the placenta may attach to the uterine scar (causing placenta previa or accreta)
• Increase in blood loss
• Faster recovery

The risk of issues with the placenta increases after each C-section.

Babies born by C-section are also more likely to have early difficulties with breathing. “Vaginal birth helps to squeeze fluid out of the baby’s lungs,” Balles said. “So those born by C-section are more likely to have trouble breathing. Most of these difficulties are minor and resolve without issue.”

In some cases, though, the baby may need to be admitted to the NICU for observation or to be treated.

What are the chances of having a VBAC?

Around three-quarters of vaginal births after C-section happen as planned. The chances of a successful VBAC are increased if the individual has had a vaginal birth before and the reason for the prior C-section is not a factor this time – such as a prior breech (or feet-first) birth that resulted in a C-section, while the baby’s head is facing downward this time.

The chance of a VBAC decreases if:

• Drugs like Pitocin or others are used to induce or augment labor
• Your BMI is over 30
• You are 35 years of age or older

Even with these decreased chances, there is still a greater than 50% chance of having a vaginal birth.

There’s just no way to know for certain whether someone will have a VBAC. If it’s important to you, speak with your certified nurse midwife or OB/GYN early in the pregnancy to get an idea of what that will look like for your unique pregnancy.

Do OB/GYNs offer VBAC as an option or only midwives?

“Both OB/GYNs and CNMs offer VBAC as an option,” Balles said. “And there is always an obstetrician immediately available in case an emergency C-section becomes necessary.”

Both mother and baby will be monitored continuously throughout labor for signs of uterine rupture or fetal distress so that care can be provided as quickly as possible, but it’s rare that any intervention is required.