VBAC (vaginal delivery after caesarean)
A VBAC is a vaginal delivery after you’ve had a cesarean.
Years ago women who’d had a baby by cesarean were advised to have them for any further babies, because it was thought there was a risk of uterine rupture from the strain of labor contractions on the cesarean scar. Now, most doctors feel it’s safer for women to attempt a VBAC because of the strain placed on the scar tissue by repeat cesareans.
Most studies suggest that 60-80 percent of women who’ve previously had a cesarean go on to have successful vaginal deliveries. As a rule, if the same reasons you had the first cesarean exist with your second pregnancy – for instance, your baby is breech, you’re pregnant with twins or multiples, you’re carrying a very large baby or you fall into another high-risk category, you’ll probably be advised to have another c-section. If you’ve had a straightforward pregnancy (or your last baby was breech but this one isn't) there’s no reason why you shouldn’t attempt a VBAC.
Some doctors or midwives call a VBAC delivery a ‘trial of labor’ because you’ll be monitored throughout to see if your body and baby can attempt a VBAC. You’re more likely to have a successful VBAC if your previous cesarean was because your baby was breech, or if you’ve already delivered vaginally in the past. The success rates are lower if you have already had one cesarean, particularly if it was because your pelvis was too small for your baby’s head to fit through. If you were given Pitocin to induce labor, a VBAC isn’t recommended, as it causes very strong contractions that could potentially rupture an old cesarean scar.
Can I have a VBAC if I’ve had two cesareans?
You’ll have to talk this over with your OB-GYN, who’ll take your previous cesareans into consideration. It may be possible though it’s likely you’ll be advised against it if you have any other uterine scars or previous ruptures.
What if my OB-GYN advises against a VBAC?
Bear in mind that your OB-GYN will have made her recommendation based on an assessment of the risks to you and your baby. If you still want to try to deliver naturally, you may be able to arrange for a nurse-midwife to supervise a trial of labor as long as it’s likely your delivery will otherwise be straightforward. Whatever happens, try to remember that what matters most is your baby being born safe and well – not how he’s delivered.
The information in this feature is intended for educational purposes only. If you have any concerns about your health, the health of your child or the health of someone you know, please consult with a doctor or other healthcare professional.