If you are interested in a VBAC, you may have some questions and concerns. You may want to know if you are a good candidate for one, what VBACs are like, and any potential risks involved to both you and your baby. Here, we’ll cover everything you might want to know to make the decision on whether to try for a VBAC.
What Parents Should Know
VBAC stands for vaginal birth after cesarean delivery, and refers to a successful vaginal birth after a previous C-section delivery. About 30% of births in America take place via C-section, and although C-sections have their place and can save lives, they are a challenging experience and require longer recovery times than vaginal deliveries. As such, many parents prefer to have a less complicated delivery after a previous C-section. There is a different term for an attempted VBAC. When you are planning to have a VBAC, this is referred to as trial of labor after cesarean delivery (TOLAC). When the attempt is successful, it is then called a vaginal birth after cesarean delivery, or VBAC.
Advantages of VBACs
There are several reasons why someone might be interested in having a VBAC, says James Miller, MD, an OB/GYN in Wooster, Ohio. “Some patients wish to experience labor and vaginal delivery,” he says. “Others may have had a bad experience with their C-section and wish to avoid another.” Some parents may be planning to have many children and want to refrain from multiple surgeries, he adds. Vaginal births have several advantages, explains David Caiseda, MD, an OB/GYN at UM Charles Regional Medical Group – Women’s Health in La Plata, Maryland. These benefits include a faster recovery, a shorter hospital stay, fewer complications, less bleeding, and a reduced need for a blood transfusion. Additional positives may include less of a chance of thrombosis (blood clots), decreased need for narcotic and pain medication, and a quicker return to pre-pregnancy activities.
Who Can Have a VBAC?
VBACs are options for many birthing people, but not everyone is a good candidate, says Dr. Miller. “Criteria for a VBAC recommendation will differ from provider to provider,” he says. For example, many physicians will not let patients who have had more than two C-sections attempt a VBAC. “A history of one prior C-section attempt at a VBAC has been well studied, but safety beyond a history of two C-sections is unknown,” he explains. “For this reason, many providers will not provide medical coverage for patients with a history of two or more C-sections.” The type of C-section you had previously may also determine whether you are a good candidate for a VBAC. As Dr. Caiseda explains, having had a previous low transverse (horizontal) C-section is the lowest risk. This is because other types of C-sections, like low vertical and high vertical, put you at higher risk of uterine rupture during a VBAC. When deciding whether a patient is a good candidate for a VBAC, most physicians will use a risk calculator, Dr. Miller says. These calculators look at factors such as age, BMI, blood pressure, a history of vaginal delivery, and characteristics of previous labors to determine whether a VBAC is safe.
What Do VBACs Involve?
Many parents wonder what a VBAC will be like for them and whether VBACs are different from other vaginal births. Although you should expect more surveillance from your medical and support team, your birth itself likely won’t be much different than any other vaginal birth, says Dr. Caiseda. “The patient should expect the same as for any expecting parent having a vaginal birth,” Dr. Caiseda describes. “They will need to wait for signs of labor like contractions and rupture of membranes.” Dr. Miller adds that VBACs, whether they involve induction or natural labor, might include minor medical adjustments. “For instance, women attempting VBAC may not be eligible for laboring in a tub or intermittent monitoring.” Of course, as Dr. Miller points out, each physician and hospital facility will vary in their rules and approach to VBACs.
Tips for Successful VBACs
It’s important to keep in mind that when it comes to VBACs, some things are out of your control, and you need to see how your body reacts to labor and childbirth. Some birthing people may end up needing a repeat C-section. But others will be able to have a VBAC. Dr. Miller says you should prepare for your birth as you would for any vaginal birth, but it makes sense to pay special attention to maintaining a healthy lifestyle, with regular exercise and a balanced diet. “A healthy lifestyle leads to a healthier pregnancy, making it more likely you have a successful VBAC,” Dr. Miller advises. “Stretching such as yoga will increase hip flexibility and increase your likelihood of a successful VBAC.”
Potential Challenges
It’s important to have realistic expectations when attempting a VBAC. “The patient should be ready for the possibility that the VBAC may not be successful and there will be a need for a repeat C- section,” says Dr. Caiseda. Overall, the success rate for VBACs is about 60-80%. It’s also important to keep in mind that although complications are rare, they can happen, and VBAC complications can be quite serious. The biggest possible complication is a uterine rupture. “This is when the scar on your uterus from your previous cesarean section comes apart during labor,” Dr. Miller describes. This outcome is rare—about 1% of people attempting VBACs experience uterine rupture—but when it happens, it can be catastrophic, says Dr. Miller. “If your uterine scar opens, your baby may end up in your abdomen,” he says. “The baby may take its first breath inside your abdomen where oxygen is low.” This can lead to long-term complications for your baby and can be fatal, Dr. Miller explains. This is why the type of C-section you previously had is such an important factor: having had a low transverse scar puts you at the lowest risk of a uterine rupture. Going into labor without artificial induction can also decrease your risk of uterine rupture, says Dr. Miller. Studies have shown that people with induced labor had a higher risk of uterine rupture compared to people with spontaneous labor. Still, getting induced with a medication like Pitocin doesn’t mean you can’t have a VBAC, he says. Each birthing person is different and you and your physician will determine the best course of action, given the various factors surrounding your birth.
A Word From Verywell
VBACs are a great option for many expectant parents, and most attempts at VBACs are successful. That said, sometimes life has other plans, and if your VBAC didn’t work out, you aren’t any less of an awesome person or parent. If you have further questions about how to optimize your chances of a successful and safe VBAC for your current pregnancy or future pregnancies, don’t hesitate to reach out to your healthcare provider.
