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Vaginal birth after a Cesarean

  • If you have already had an emergency or planned Cesarean, you may be able to attempt a vaginal birth with this baby. This birth is known as a VBAC.

    The decision will be one that you and your health care provider will make together.

    Guideline for VBAC

    These are the guidelines for being able to have a VBAC, according to the American College of Obstetricians and Gynecologists (ACOG):

    • you had a low-transverse uterine incision from one previous Cesarean birth (If the scar is on the upper part of your uterus, you should not try to have a VBAC.)
    • your uterus does not have scar tissue or it has not ruptured
    • the size of your pelvis is wide enough to attempt a vaginal birth and you have not had any pelvic problems
    • you have no other restrictions

    You should not attempt a home vaginal birth. The ACOG recommends that a surgeon, nurses and an anesthesiologist are immediately available in case an emergency Cesarean is needed.

    Reasons to consider a VBAC

    For you:

    • no major abdominal surgery
    • a shorter hospital stay
    • lower risk of infection
    • lower need for a blood transfusion
    • quicker recovery
    • easier time breastfeeding

    For your baby:

    • easier to breathe (fluid is pushed out of the baby's lungs when coming through the birth canal)
    • more contact with you right after birth
    • able to breastfeed right away
    • easier to breastfeed

    Risks of a VBAC

    You and your health care provider should review the benefits and risks of a VBAC and consider what is best for you. He or she will fully talk about the risks with you.

    There is no guarantee that a VBAC will work. About 60 to 80 percent of women who try a VBAC are successful.

    If it is not successful and a Cesarean is needed, the risk of problems for both you and your baby is greater with an unplanned or emergency Cesarean than with a planned repeat Cesarean.

    There is an increased risk of uterine rupture, which is a tear or opening in the uterus. This happens for five to 15 out of every 1,000 women who try a VBAC. The risk is slightly higher for a VBAC than for other vaginal deliveries.

    Pain control

    You have options to control pain during a labor and vaginal birth. The most common option is a labor epidural.

    The doctor inserts a small catheter (thin plastic tube) into your lower back. The tip of the catheter rests in the area just outside the spinal cord. This area is called the epidural space. Medicines to control labor pain are given through the catheter

    Your health care provider will explain the benefits and risks of a labor epidural. He or she can explain other pain control options that are available. Together, you and your health care provider can create a pain management plan before your delivery.

    Your feelings

    You may have mixed or negative feelings about giving birth vaginally.

    You may be afraid to attempt labor, not knowing what to expect. You may favor a Cesarean because you know what to expect. If your last birth started with labor and ended with a Cesarean, you may not want to go through labor again.

    Remember, each pregnancy and labor is different. In deciding if a VBAC is right for you, your health care provider will take your specific health into account.

    Childbirth and VBAC classes can help answer your questions.

  • Tip

    Watch a short video on labor epidurals.