Vaginal Birth After Cesarean (VBAC)
Medically reviewed by Dr. Lisa Okafor, MD, FACOG · Board-Certified OB-GYN
Content reviewed against published ACOG, NIH, March of Dimes guidelines
Last reviewed:
Your health matters just as much as your baby's. If you are dealing with vaginal birth after cesarean (vbac), here is what you need to know.
The short answer
Vaginal birth after cesarean (VBAC) is a safe option for many people, with success rates of 60-80% for those who attempt a trial of labor after cesarean (TOLAC). The main concern is uterine rupture, which occurs in less than 1% of cases. VBAC offers benefits including shorter recovery, lower infection risk, and fewer complications in future pregnancies.
Key takeaways
- Vaginal birth after cesarean (VBAC) is a safe option for many people, with success rates of 60-80% for those who attempt a trial of labor after cesarean (TOLAC). The main concern is uterine rupture, which occurs in less than 1% of cases. VBAC offers benefits including shorter recovery, lower infection risk, and fewer complications in future pregnancies.
- Usually normal when: Having questions about whether VBAC is right for you
- Call your doctor if: During a TOLAC: sudden severe abdominal pain, heavy bleeding, or fetal heart rate changes
- Varies by age — see the age-by-age breakdown below
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What Parents Should Know
According to ACOG, NIH, March of Dimes guidelines, vaginal birth after cesarean (VBAC) is a safe option for many people, with success rates of 60-80% for those who attempt a trial of labor after cesarean (TOLAC). The main concern is uterine rupture, which occurs in less than 1% of cases. VBAC offers benefits including shorter recovery, lower infection risk, and fewer complications in future pregnancies. At First trimester, early pregnancy is a good time to discuss VBAC with your provider. Factors that favor VBAC success include: previous vaginal delivery, spontaneous labor, single low-transverse uterine incision, and the reason for the prior cesarean being non-recurring. Your provider can help assess your individual likelihood of success. It is generally considered normal when having questions about whether VBAC is right for you. However, you should contact your pediatrician promptly if during a TOLAC: sudden severe abdominal pain, heavy bleeding, or fetal heart rate changes.
Normal vs. Concerning
By Age
What to expect by age
First trimester
Early pregnancy is a good time to discuss VBAC with your provider. Factors that favor VBAC success include: previous vaginal delivery, spontaneous labor, single low-transverse uterine incision, and the reason for the prior cesarean being non-recurring. Your provider can help assess your individual likelihood of success.
Third trimester
If planning VBAC, choose a hospital with surgical capability in case of emergency. Continuous fetal monitoring during labor is recommended. Discuss signs of uterine rupture with your provider. Having a clear plan, including what would lead to a repeat cesarean, helps you feel prepared for any outcome.
Labor & delivery
During a TOLAC, your care team will monitor you and the baby closely. Most VBAC labors progress normally. If labor stalls, if there are signs of fetal distress, or if uterine rupture is suspected, a cesarean will be performed. A successful VBAC typically means a faster recovery than a repeat cesarean.
What to Tell Your Pediatrician
- Describe when you first noticed vaginal birth after cesarean (vbac) and how it has changed over time.
- Note your baby's current age and which age-specific patterns you are seeing.
- Mention if you want to attempt VBAC and need to find a supportive provider and facility.
- Mention if you had a previous uterine surgery beyond a standard cesarean.
- Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
- Bring a list of any questions or observations you want to discuss at the appointment.
What Should You Do?
When to take action
- Having questions about whether VBAC is right for you
- Feeling nervous about both options (VBAC and repeat cesarean)
- Wanting to understand the risks and benefits of each option
- You want to attempt VBAC and need to find a supportive provider and facility
- You had a previous uterine surgery beyond a standard cesarean
- You have questions about your specific risk factors
- During a TOLAC: sudden severe abdominal pain, heavy bleeding, or fetal heart rate changes
- Feeling something "give way" or "pop" in your abdomen during labor
What You Can Do at Home
- Keep track of when you notice vaginal birth after cesarean (vbac) — noting the time of day, duration, and any triggers can help your pediatrician.
- Remember that having questions about whether VBAC is right for you — this is generally within the range of normal.
- At First trimester, focus on observation rather than intervention unless your pediatrician advises otherwise.
- Prioritize your own rest and nutrition. Accept help when offered, and do not hesitate to reach out to your healthcare provider.
- While monitoring at home, seek immediate care if during a TOLAC: sudden severe abdominal pain, heavy bleeding, or fetal heart rate changes.
Related Conditions
C-Section Recovery
Recovery from a cesarean section is a major abdominal surgery recovery, and it typically takes six to eight weeks for the initial healing and several months to feel fully yourself again. It is important to be patient with your body, follow your provider's guidance on activity restrictions, and watch for signs of infection at the incision site.
C-Section Scar: Numbness, Appearance, and Healing
C-section scar healing is a gradual process that unfolds over many months. Numbness around the incision site is extremely common and occurs because small sensory nerves are cut during surgery. The scar itself typically evolves from red and raised to flat and pale over 6 to 18 months. While most scars heal well with basic care, some women experience complications like infection, keloid formation, or persistent pain that benefit from medical attention.
When Birth Does Not Go as Planned
It is very common for birth to unfold differently than planned. About 1 in 3 births in the US involve cesarean delivery, and many other births involve unplanned interventions. Feeling disappointed, sad, or even grieving the birth experience you envisioned is completely valid. What matters most is that you and your baby are safe, but your feelings about the experience also matter.
Related Resources
Postpartum Recovery Guide
Week-by-week postpartum recovery timeline and warning signs.
Month-by-Month Development
Detailed monthly development guides from birth through 24 months.
When to Call the Doctor
General guide on when to call the pediatrician, visit urgent care, or go to the ER.
Frequently asked questions
Is vaginal birth after cesarean (vbac) normal?
When should I call the doctor about vaginal birth after cesarean (vbac)?
When is vaginal birth after cesarean (vbac) normal?
What causes vaginal birth after cesarean (vbac)?
What should I mention to my pediatrician about vaginal birth after cesarean (vbac)?
Is vaginal birth after cesarean (vbac) normal at First trimester?
Is vaginal birth after cesarean (vbac) normal at Third trimester?
Should I go to the ER for vaginal birth after cesarean (vbac)?
Does vaginal birth after cesarean (vbac) go away on its own?
References
- [1]American College of Obstetricians and Gynecologists. Vaginal Birth After Cesarean Delivery. ACOG Practice Bulletin No. 205, 2019. ACOG
- [2]National Institutes of Health. NIH Consensus Development Conference Statement: Vaginal Birth After Cesarean, 2010. NIH
- [3]March of Dimes. Vaginal Birth After Cesarean. March of Dimes, 2023. March of Dimes
Doctor Visit Checklist
Bring this checklist to your next pediatrician visit to discuss Vaginal Birth After Cesarean (VBAC).
Things to mention
- Describe when you first noticed vaginal birth after cesarean (vbac) and how it has changed over time.
- Note your baby's current age and which age-specific patterns you are seeing.
- Mention if you want to attempt VBAC and need to find a supportive provider and facility.
- Mention if you had a previous uterine surgery beyond a standard cesarean.
- Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
- Bring a list of any questions or observations you want to discuss at the appointment.
Observations to share
- You want to attempt VBAC and need to find a supportive provider and facility
- You had a previous uterine surgery beyond a standard cesarean
- You have questions about your specific risk factors
Urgent signs to report immediately
- During a TOLAC: sudden severe abdominal pain, heavy bleeding, or fetal heart rate changes
- Feeling something "give way" or "pop" in your abdomen during labor
My notes
From ismybabyalright.com — free, evidence-based baby health guides
All content follows our editorial policy and is reviewed against published clinical guidelines.
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Related Resources
Bottom line
Most cases of vaginal birth after cesarean (vbac) are normal. Talk to your pediatrician if during a tolac: sudden severe abdominal pain, heavy bleeding, or fetal heart rate changes.
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.
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Related Maternal Concerns
C-Section Recovery
Recovery from a cesarean section is a major abdominal surgery recovery, and it typically takes six to eight weeks for the initial healing and several months to feel fully yourself again. It is important to be patient with your body, follow your provider's guidance on activity restrictions, and watch for signs of infection at the incision site.
C-Section Scar: Numbness, Appearance, and Healing
C-section scar healing is a gradual process that unfolds over many months. Numbness around the incision site is extremely common and occurs because small sensory nerves are cut during surgery. The scar itself typically evolves from red and raised to flat and pale over 6 to 18 months. While most scars heal well with basic care, some women experience complications like infection, keloid formation, or persistent pain that benefit from medical attention.
When Birth Does Not Go as Planned
It is very common for birth to unfold differently than planned. About 1 in 3 births in the US involve cesarean delivery, and many other births involve unplanned interventions. Feeling disappointed, sad, or even grieving the birth experience you envisioned is completely valid. What matters most is that you and your baby are safe, but your feelings about the experience also matter.
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An abnormal prenatal screening result can be terrifying, but it is important to understand that screening tests are designed to cast a wide net and have significant false-positive rates. Most people with abnormal screening results go on to have healthy babies after further testing confirms the baby is fine. An abnormal screening is a reason for more information, not a diagnosis.
Pregnancy Over 35 (Advanced Maternal Age)
While pregnancy after 35 carries some increased risks (including chromosomal abnormalities, gestational diabetes, and hypertension), the vast majority of people over 35 have healthy pregnancies and healthy babies. The term "geriatric pregnancy" is outdated and does not reflect reality. With appropriate prenatal care and monitoring, outcomes are excellent.
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Amniocentesis is a diagnostic test performed between 15-20 weeks that analyzes amniotic fluid to detect chromosomal conditions and genetic disorders with over 99% accuracy. The risk of pregnancy loss from the procedure is approximately 1 in 500-1,000 when performed by an experienced provider. Understanding the actual risks can help you make an informed decision.