What Is a VBAC? : Understanding Birthing Options After C-Section

Content medically reviewed by Michaela Heller, MD

If you had a cesarean delivery, also called a C-section, with a previous pregnancy, you may have more birthing options for future pregnancies than you realize. A vaginal birth after cesarean, or VBAC, can be an excellent choice for many who had a previous C-section.

“The most common misconception I come across is patients believe once they have a C-section, they always have to have one for future deliveries,” said Michaela Heller, MD, OB/GYN at Essentia Health. “If a person is a good candidate, a VBAC has a success rate of 60% to 80%.”

Risks & Benefits of a VBAC

Talk to your provider to weigh the risks and benefits to help determine if a VBAC is a possible option for you. Compared to repeated cesarean deliveries, VBAC offers several benefits, including –

• Decreased risk of blood loss and infection
• Faster recovery
• Lower risk of emergency hysterectomy or injuries to the bladder or bowel
• No surgery
• Shorter hospital stay

The most serious risk of a VBAC is the risk of uterine rupture, which is rare but can be life-threatening. A uterine rupture occurs when the scar on the uterus from the previous C-section breaks open. People who had a vertical incision, or an up-and-down surgical cut, during their C-section have the highest risk.

“For most patients, a C-section carries greater risk than a vaginal delivery,” Dr. Heller said. “A repeat C-section increases the risk of complications. Because each subsequent C-section is riskier than the one before, a VBAC could be considered for the right patients.”

When VBAC Might Be Right for You

A successful VBAC is possible for many patients, especially those who are in good health and have only had one previous C-section. However, a planned cesarean delivery may be safer for those with a higher risk of VBAC complications.

A VBAC may not be right for you if you –

• Are expecting triplets or a higher number of multiples
• Are of higher weight
• Are over age 35
• Are past your due date, or labor needs to be induced
• Develop preeclampsia, or high blood pressure during pregnancy
• Had a previous uterine rupture

Have had more than one C-section in the past or other surgery at the top part of the uterus, such as surgery for uterine fibroids

A cesarean delivery may be appropriate if your baby –

• Shows signs of distress in labor
• Is breech, or has their feet down when it’s time for delivery
• Is large for their gestational age

Preparing for a VBAC

The first step in preparing for a VBAC is having a conversation with your provider. It’s essential to know your personal risk factors and what’s most important to you before deciding. Even if you share the same risk factors as another patient, you may not make the same decision. Talking with your provider about your birthing options will help you make the best decision and birth plan for you and your baby.

“Data shows that although serious complications can occur, they are rare,” Dr. Heller said. “The challenge is that we can only do so much to predict if a patient will have a successful VBAC. It’s important to have an open and thorough conversation with your doctor about your best option.”

While the majority of VBACs are successful, complications during the delivery may make an emergency C-section necessary. Because of this, creating a detailed birth plan with your provider is crucial if you choose VBAC. Being prepared for the delivery day can help so you can focus on what’s most important—welcoming your new little one to the world.