Is Vaginal Birth After C Section Possible? Benefits & Risks

You can safely have a vaginal birth in subsequent pregnancies if you meet certain factors.

Medically reviewed by Dr. Shweta Shah, MS, DNB Dr. Shweta Shah Dr. Shweta ShahMS, DNB facebook_icontwitter_iconlinkedin_iconyoutube_iconinsta_icon Specialty: Gynecology & Laparoscopic SurgeryExperience: 5 years
Written by Pragya Bhargavi
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VBAC (Vaginal Birth After C-Section): Benefits And Risk

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If your previous births were through cesarean and you plan to have your next delivery vaginally, it is termed as VBAC, meaning vaginal birth after cesarean or C-section.

Previously, there was a claim that pregnant women who had a cesarean would need to undergo the same procedure for future deliveries. However, this claim is now unproven. As per 2013 data, VBAC after one C-section had a 70.4% success rate, while VBAC after two or more cesareans had a 51.4% success rate (1).

Read on to know more about VBAC, the risks, benefits, and a few preparation strategies for it.

What Are The Chances Of A Successful VBAC?

Several factors related to your health and previous modes of delivery determine whether or not a VBAC will work for you. Nevertheless, it has been observed that women considered to have a low chance of a successful VBAC delivery could still have a vaginal birth if they try for it (2).

According to the American College of Obstetricians and Gynecologists (ACOG), the following factors make you a good candidate for a VBAC (3) (4).

  • Having a low-transverse uterine incision (horizontal incision) as opposed to a high vertical incision (classical incision)
  • No history of uterine rupture or surgery
  • No prevalence of risky medical conditions, such as large fibroid or placenta previa
  • Having a vaginal delivery at least once before the C-section
  • An unplanned onset of labor

What Factors Decrease The Chances Of A Successful VBAC?

Some factors that would make a VBAC less likely are (5):

  • Age more than 35 years
  • More than three previous cesarean deliveries
  • Complicated pregnancy that requires a C-section
  • Being overweight or obese
  • Having a baby with a high birth weight (over 8.8 pounds)
  • A history of having induced labor
  • A time period of 18 months or less between previous and current pregnancies
  • Abnormal position of the baby, like breech or transverse
  • Any uterine abnormalities, which lead to abnormal position of the baby
  • Twin or multifetal gestation

How Can VBAC Be Helpful?

Most women want to attempt a trial of labor after a C-section because of its several benefits.
Below are some of the benefits of VBAC (6).

  1. Helps plan safer future pregnancies: If a woman wants to have more children, it is better to opt for a VBAC because it helps her prevent future complications, such as bladder injuries, placenta previa, and hysterectomy, which come with multiple cesarean births (7).
  1. Lower the risk of surgical complications: The risk of surgical complications increase with each C-section due to the previous scarring. A successful VBAC can reduce this risk. Moreover, surgical complications such as blood clots, excessive blood loss, organ damage, and infection can also be effectively prevented by a VBAC.
  1. Recovery within a short period: Since cesarean is a surgical procedure, recovery takes time, which, in turn, prolongs a woman’s stay at the hospital. On the contrary, vaginal birth after a cesarean allows a woman to recover faster because it does not involve any major surgical procedure.
  1. Less risk for babies to develop respiratory issues: Babies born through vaginal birth have a lower risk of developing respiratory problems because the lungs clear as the babies pass through the birth canal.

What Are The Risks Of VBAC?

If you are a good candidate for VBAC, there are high chances that the delivery will be successful. It is rare to experience complications. However, if, by any chance, the VBAC fails, it may lead to the following problems (2).

  • There are chances of uterine rupture at the site of the previous cesarean scar. This might result in loss of blood and cause damage to both mother and baby. However, the chance of a uterine rupture during VBAC is only around 0.5%. Most uterine ruptures are controlled before they become serious.
  • If you plan to have a VBAC, you need to go through labor pain. If VBAC is successful, you will be at a much lower risk of any complications. However, if you require an emergency C-section after the onset of labor pain, the risk of complications increases.

How To Prepare For A VBAC?

If you are pregnant and want to have a vaginal birth after C-section, it is best to talk to your healthcare provider about it. Your healthcare provider will go through your medical history and previous C-section details and then help you decide whether or not you are eligible for a VBAC.

It is also important to choose a hospital that is prepared to provide emergency assistance if required. A few other things that you can do to increase your chances of a successful VBAC are (8):

  • Read and stay well-informed about VBAC
  • Eat nutritious food and stay active during pregnancy
  • If possible, try to have natural labor rather than an induced one
  • Keep your expectations flexible; be prepared to opt for a cesarean if the need arises

Frequently Asked Questions

1. How much gap is needed for normal delivery after C-section?

A considerable gap after a C-section could help your body recover for a vaginal delivery. The optimal gap between these two methods should at least be six months, but the preferable gap is 12-18 months (9)

2. How long is labor for VBAC?

The labor process for a VBAC is similar to that of vaginal delivery. Hence, you may also expect similar preparations. But one additional care you must take is to choose a hospital that can operate an emergency C-section in case any complications arise during the VBAC (10).

3. Is VBAC safer than repeat cesarean?

A VBAC could have fewer complications if planned right. However, the occurrence of fewer complications is dependent on your eligibility for a VBAC. Hence, if you choose to opt for VBAC, confirm with your ob/GYN that you meet the criteria for the procedure (11).

4. What is a good VBAC score?

A VBAC score is a method of determining the success rate of vaginal birth after a C-section. The score has six components, with each component assigned one or two points. The total score sums up to 10. The medical practitioner might use this score to determine a pregnant woman’s eligibility for VBAC. A score greater than seven means a reasonable success rate of VBAC (12).

VBAC could be a viable option for you when planning your next delivery. Before opting for a vaginal birth after C-section, have a detailed discussion with your healthcare provider to find what suits you the best. Choose a hospital that will provide you the flexibility of VBAC with an option of C-section in case of emergencies. Remember to be flexible and choose the mode of delivery that is safest for you and your little one.

Key Pointers

  • Age over 35, obesity, a history of more than one cesarean delivery, and other factors decrease the chance of a VBAC.
  • VBAC lowers the risk of respiratory difficulties in newborns and minimizes surgical complications.
  • A healthy lifestyle, nutritious meals, and natural labor may help you have a successful VBAC.

References

  1. Choosing the route of delivery after cesarean birth.
    https://www.uptodate.com/contents/choosing-the-route-of-delivery-after-cesarean-birth
  2. Thinking about VBAC: Deciding what’s right for me.
    https://www.ontariomidwives.ca/sites/default/files/2017-06/Thinking-about-VBAC-English.pdf
  3. Practice Bulletin No. 184: Vaginal Birth After Cesarean Delivery.
    https://journals.lww.com/greenjournal/Fulltext/2017/11000/Practice_Bulletin_No__184__Vaginal_Birth_After.48.aspx
  4. Vaginal Birth After Cesarean Delivery (VBAC).
    https://www.acog.org/womens-health/faqs/vaginal-birth-after-cesarean-delivery
  5. Vaginal Birth After Cesarean.
    https://www.marchofdimes.org/pregnancy/vaginal-birth-after-cesarean.aspx
  6. Vaginal Birth after Caesarean Section.
    https://ranzcog.edu.au/womens-health/patient-information-resources/vaginal-birth-after-caesarean-section
  7. Hysterectomy (surgical removal of the womb).
    https://www.ncbi.nlm.nih.gov/books/NBK525761/
  8. Vaginal birth after caesarean (VBAC).
    https://www.pregnancybirthbaby.org.au/vaginal-birth-after-caesarean-vbac
  9. Pregnancy and giving borth after cesarian section.
    https://www.tommys.org/pregnancy-information/giving-birth/after-caesarean-section
  10. Vaginal birth after cesarean (VBAC).
    https://www.mayoclinic.org/tests-procedures/vbac/about/pac-20395249
  11. VBAC: Know the pros and cons.
    https://www.mayoclinic.org/tests-procedures/vbac/in-depth/vbac/art-20044869
  12. Bruce Meyer and Kerri Osterhaus. VBAC scoring to predict vaginal delivery after cesarean section.
    https://www.ajog.org/article/S0002-9378(03)01508-4/fulltext
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Dr. Shweta Shah
Dr. Shweta ShahMS, DNB
Dr. Shweta is a passionate and skilled gynecologist with over five years of experience in her field. She is a woman who connects and resonates with her patients, like her beloved family. She is a prolific doctor who can be related to women across all walks of life.

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