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you have had a
cesarean delivery (also called a C-section) before,
you may be able to deliver your next baby vaginally. This is called vaginal
birth after cesarean, or VBAC.
Most women, whether they deliver
vaginally or by C-section, don't have serious problems from childbirth.
If you and your doctor agree to try a VBAC, you
will have what is called a "trial of labor after cesarean," or TOLAC. This means that you plan to go
into labor with the goal to deliver vaginally. But as in any labor, it is hard
to know if a VBAC will work. You still may need a C-section. As many as 4 out
of 10 women who have a trial of labor need to have a C-section.1
Having a vaginal birth after having a C-section can be a safe choice for most women. Whether it is right for you depends on several things, including why you had a C-section before and how many C-sections you've had. You and your doctor can talk about your risk for having problems during a trial of labor.
A woman who chooses VBAC is closely monitored. As with any labor,
if the mother or baby shows signs of distress, an emergency cesarean section is
The benefits of a
VBAC compared to a C-section include:
The most serious risk
of a trial of labor is that a C-section scar could come open during labor. This is very
rare. But when it does happen, it can be very serious for both the mother and
the baby. The risk that a scar will tear open is very low during VBAC when you
have just one low cesarean scar and your labor is not started with medicine.
This risk is why VBAC is often only offered by hospitals that can do a rapid
If you have a trial of labor and need to
have a C-section, your risk of infection is slightly higher than if you just
had a C-section.
Learning about VBAC:
Health Tools help you make wise health decisions or take action to improve your health.
Having a vaginal
birth after having a C-section can be a safe choice for most women. But it can have risks for both the mother and the baby. Whether VBAC is right for you depends on what
risk factors (things that increase your risk) you have that could make it unsafe. You and your doctor can decide whether VBAC is right for you.
As with a first-time childbirth, even if you are a good
candidate for a successful VBAC, there is no guarantee that you will give birth
vaginally and without complications.
Pregnancy, labor, and
delivery are different for every woman and difficult to predict. Even if your
first pregnancy required a cesarean, the next one may not. The likelihood of a
vaginal birth after cesarean (VBAC) is influenced by
many things. Usually a combination of things affects how well or poorly a
trial of labor goes.
Your chances of a successful VBAC are best when:1
Your chances of a successful VBAC are lower when:2
VBAC can be considered for pregnancies with twins.
deliver vaginally or by cesarean section, you are unlikely to have serious
complications. Overall, a routine vaginal delivery is less risky than a routine
cesarean, which is a major surgery. But a pregnant woman who has a cesarean scar
on the uterus has a slight risk of the scar breaking open during labor. This
is called uterine rupture.
Although rare, uterine rupture can be
life-threatening for both mother and baby. So women with risk factors for
uterine rupture should not attempt a
vaginal birth after cesarean (VBAC).
The risks of VBAC include:
The risks of cesarean
Future risks. If you
are planning to get pregnant again, it's important to think about scarring.
After you have two C-section scars, each added scar in the uterus raises the
placenta problems in a later pregnancy. These problems
placenta previa and
placenta accreta, which raise the risk of problems for
the baby and your risk of needing a
hysterectomy to stop bleeding.
For more information about cesarean risks, see
Besides the usual prenatal tests,
your doctor will take measures to assess whether vaginal delivery is likely to
be a safe birthing option for you. (For more information on standard prenatal
tests, see the topic Pregnancy.) These extra measures can help you and your
doctor make a well-informed decision about your delivery.
Assessments done sometime during the pregnancy to help find out whether
a trial of labor is a safe option
Information, preparation, and
teamwork are needed for a successful
vaginal birth after cesarean (VBAC).
To prepare for
labor, consider taking a childbirth education class at your local hospital or
clinic. You and your birthing partner can learn:
Other than requiring closer monitoring,
trial of labor after cesarean, or TOLAC labor, is the same as normal labor. During early labor, a woman can
remain as active and mobile as she wants. There are no specific restrictions
for TOLAC until active labor begins. During the
active period of labor, continuous fetal heart
monitoring is done to watch for early signs of fetal distress or uterine
rupture. (For more information, see Exams and Tests.)
If you are attempting trial of labor and you have not
had a previous vaginal birth or your previous cesarean was done early on in
labor, your labor will be like a first-time labor.
For more information about labor and delivery, see the
Labor and Delivery.
As the end of pregnancy nears, the cervix normally becomes soft and begins to open (dilate) and thin (efface), preparing for labor and delivery. When labor does not naturally start on its own, labor may be started artificially (induced).
Some doctors avoid the use of any medicine to start (induce) a trial
of labor, because they are concerned about uterine rupture. Other doctors are comfortable with the careful use of
oxytocin (Pitocin) to start labor when the cervix is
soft and opening (dilating).
If your labor slows or stops progressing, your doctor may use oxytocin to
strengthen (augment) contractions.
As with most vaginal births, most
women who choose VBAC can safely use pain medicine during labor.
Pain medicine usually is started when the
cervix has opened (dilated)
3 cm (1.2 in.) to
4 cm (1.6 in.). Types of pain
medicines used include:
Vaginal birth after cesarean (VBAC) recovery is similar to recovery after any vaginal birth.
After a vaginal delivery, the mother and baby can usually go home within 24 to
48 hours. By comparison, recovery from a cesarean section requires 2 to 4 days
in the hospital and a period of limited activity as the incision heals.
The overall risk of infection is low for both vaginal and cesarean
deliveries. But it is lower after a vaginal birth. Before you leave the
hospital, you will receive a list of signs of infection to watch for in the
first few weeks after delivery.
For more information, see:
Any woman in labor—not just one
vaginal birth after cesarean (VBAC)—might have
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, though, to fear going through labor after
having had a cesarean delivery. This is especially true for women who have
tried a vaginal birth but, after a long and difficult labor, ended up
delivering by cesarean.
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 and does not have a clear reason, consider getting a second
If you are considering VBAC, talk
with your doctor about:
American College of Obstetricians and Gynecologists
(2010). Vaginal birth after previous cesarean delivery. ACOG
Practice Bulletin No. 115. Obstetrics and Gynecology,
Miller DA (2010). Vaginal birth after cesarean. In Management of Common Problems in Obstetrics and Gynecology, 5th ed., pp. 52–56. Chichester: Wiley-Blackwell.
Cunningham FG, et al. (2010). Prior cesarean
delivery. In Williams Obstetrics, 23rd ed., pp. 565–576.
New York: McGraw-Hill.
Other Works Consulted
Institute for Clinical Systems Improvement (2011). Health care guideline: Management of labor, 4th edition. Available online: https://www.icsi.org/_asset/br063k/Labor-Interactive0511.pdf.
National Institutes of Health consensus development conference statement: Vaginal birth after cesarean: New insights March 8–10, 2010.
Obstetrics and Gynecology, 115(6): 1279–1295.
March 29, 2013
Sarah Marshall, MD - Family Medicine & Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology
How this information was developed to help you make better health decisions.
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