Risks and Benefits of Vaginal Birth After Cesarean (VBAC)

In the United States, 32% of expectant mothers have a cesarean birth. As the nation’s most performed surgical procedure, C-section deliveries bring about 1 million American babies into the world every year. 

If you had a cesarean delivery with your firstborn, you may have heard that the uterine scar from your surgery can rupture during labor in a subsequent pregnancy — and that once you’ve had a C-section, it remains the safest way to deliver your future babies.  

In reality, vaginal birth after cesarean (VBAC) is a safe and viable option for many women. 

Here, board-certified obstetrician Dr. Diana Heard of Glendale Obstetrics and Gynecology, PC, addresses the risks and benefits of VBAC — and which factors can help you determine whether vaginal birth is a possibility for you.     

Understanding VBAC

Until relatively recently, women who had a C-section were told they’d have to deliver any subsequent babies the same way. There was even an expression: Once a cesarean, always a cesarean. The reason? Physicians were concerned that going through labor and a vaginal delivery after a previous C-section carried too high a risk of uterine rupture. 

Fortunately, this life-threatening problem is rare, occurring in less than 1% of women who attempt a trial of labor after cesarean (TOLAC). And VBAC is a success for 75% of women who attempt a TOLAC after one C-section and 50% who attempt vaginal delivery after two C-sections.  

Advantages of VBAC

Whether you had a previous unplanned C-section — for example, due to fetal distress or prolonged labor — or you just didn’t like the recovery process following a planned, elective C-section, VBAC has several advantages over having another C-section, including: 

Faster, easier recovery

A successful VBAC involves no surgery, meaning you can expect a shorter hospital stay and a quicker return to normal activities. It also carries none of the possible complications of another C-section, such as heavy bleeding, infection, and bladder or bowel damage.   

No repeat surgery risks 

VBAC can also safeguard future pregnancies by helping you avoid the risks associated with multiple C-sections. Having repeat cesarean deliveries increases your risk of uterine rupture in future pregnancies, including before labor and delivery. 

Repeat C-sections also increase your chances of developing placental problems in future pregnancies. Conditions like placenta previa or placenta accreta increase the risk of heavy bleeding, preterm birth, and life-threatening placental abruption (detachment).   

A health boost for baby

Vaginal childbirth can give your baby a health boost, too; passing through the birth canal helps clear amniotic fluid from their lungs, preparing them to breathe oxygen right away. It also exposes them to various microbes that fortify their immune system. 

Potential VBAC risks

Even though a successful VBAC is associated with fewer complications than elective repeat C-sections, an unsuccessful VBAC carries a risk of more serious complications.  

Uterine rupture

Because a C-section leaves a scar on your uterus, the pressure of labor and a vaginal delivery has the potential to force your uterus to open (rupture) along the scar line. This serious complication can be life-threatening for both you and your baby.    

Possible hysterectomy 

Uterine rupture typically requires an emergency C-section to deliver your baby as quickly as possible, followed by treatment to stop excessive bleeding and save your life. Often, this entails an emergency hysterectomy, the surgical removal of the uterus and the end of your ability to have a pregnancy. 

Emergency C-section

Even if uterine rupture doesn’t occur, VBAC also carries a risk of needing an emergency C-section if the attempted trial of labor fails. An emergency C-section is generally riskier than a planned cesarean birth.   

Is VBAC right for you?

Dr. Heard considers various factors when determining whether VBAC is a viable option. She may consider VBAC as safe and likely to be successful if you: 

• Had no more than two previous cesarean deliveries 
• Have a low transverse incision (the least likely to rupture)
• Haven’t had other uterine surgeries
• Have had a previous vaginal birth or successful VBAC
• Don’t have a condition that makes vaginal delivery risky

Dr. Heard is likely to advise against VBAC if you:

• Have experienced more than two cesarean births
• Have a vertical incision (the most likely to rupture) 
• Needed a C-section because of nonprogressing labor 
• Had your last baby in the past 18 months
• Have experienced a failed VBAC or uterine rupture

VBAC is also less likely to be successful if you must be induced past your due date, if you’re 35 or older, if you’re overweight, or if you’re having multiples.  

Are you contemplating VBAC? The team at Glendale Obstetrics and Gynecology, PC, can help you understand your personal risk factors and options. Call us in Glendale, Arizona, today, or request an appointment online with Dr. Heard at your convenience.