Vaginal Birth After Cesarean (VBAC): What To Think About

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What to Think About

Any woman in labor—not just one attempting a vaginal birth after cesarean (VBAC)—might develop complications during childbirth that require a cesarean section delivery.

If there is no medical reason for a cesarean, vaginal delivery is generally a safe option for both mother and baby. It is common, however, to fear going through labor after having had a cesarean delivery. This is especially true for women who have attempted a vaginal birth but, after a long and difficult labor, ended up delivering by cesarean.

Benefits of a successful VBAC include:

• Avoiding another incision in the uterus. If you are planning on a pregnancy after this one, scarring is an important factor to think about. After you have two scars, each additional scar in the uterus raises the risk of placenta problems in a later pregnancy, such as placenta previa or placenta accreta. These problems raise not only the risks for a fetus but also your risk of needing a hysterectomy to stop bleeding.⁹
• Less blood loss.
• A lower risk of infection after childbirth (though for women who are obese, infection risk is higher after a VBAC than after a cesarean¹⁰).
• A lower risk of blood clots (deep vein thrombosis).
• Greater participation in the birth.
• A quicker recovery.
• Lower costs.

The ultimate decision to try a vaginal birth is made by you and your doctor. If you want to try a VBAC, but your doctor is not in favor of your choice without a clear reason, consider getting a second opinion.

Should I have a VBAC trial of labor after a previous cesarean?

If you are considering VBAC, talk with your doctor about:

• The risks of vaginal and cesarean deliveries in your particular case. Here are some points to keep in mind:
  • Serious complications with either vaginal or cesarean births are uncommon.
  • A cesarean section is a surgical procedure and requires the use of anesthesia. Any surgery carries a risk of infection, excessive blood loss, and problems caused by the anesthesia.
  • Women who need a cesarean after a VBAC trial of labor have a higher rate of infection than those who have a cesarean without a VBAC trial of labor.¹
• Whether your doctor will be available in the hospital throughout your labor and whether the hospital has facilities for an emergency cesarean delivery.
• The possibility that a trial of labor may end in cesarean delivery.
• How and at what point during labor the decision is made to do a repeat cesarean.
• Which types of pain medicine or anesthesia you may use during labor and delivery or a cesarean.
• Your particular risk factors for uterine rupture during VBAC and the possible complications of a rupture, such as removal of the uterus (hysterectomy).

Last updated:	April 20, 2007
Author:	Kathe Gallagher, MSW
Reviewed By:	Joy Melnikow, MD, MPH - Family Medicine, Kirtly Jones, MD - Obstetrics and Gynecology
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC