Vaginal Birth After Cesarean (VBAC)
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.
Parents everywhere have the same worry. You are doing the right thing by looking into it.
By Age
What to expect by age
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.
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.
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 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
Sources
Related Resources
Trust your instincts. If something feels wrong, reach out to your pediatrician.
Worrying about your baby means you care. That is a good thing.
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.
Dealing with Abnormal Prenatal Screening Results
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.
Amniocentesis Questions and Fears
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.