Condition Basics

What is a vaginal birth after caesarean (VBAC)?

Vaginal birth after caesarean (VBAC) means delivering your baby through the birth canal after you had a caesarean section (C-section) for an earlier birth. VBAC is often safe, but it does have some risks. And it may not succeed. You may not be able to complete the birth through the vagina.

If you and your healthcare provider or midwife agree to try a VBAC, you will have what is called a "trial of labour after caesarean," or TOLAC. This means that you plan to go into labour with the goal to deliver through the birth canal. But as in any labour, it's hard to know if a VBAC will work. You still may need a C-section.

Is a VBAC safe?

Having a vaginal birth after having a C-section can be a safe choice. Whether it's right for you depends on several things, such as why you had a C-section before and how many C-sections you've had. Experts recommend having a VBAC in a hospital that can do an emergency C-section.

If you choose VBAC, you and your baby will be closely watched during labour. If you or your baby shows signs of having problems, you may have a C-section.

What are the benefits of a VBAC?

Having a vaginal birth is associated with the lowest overall risk of complications. Benefits of VBAC include:

• Avoiding surgery. All surgeries have risks, such as the risk of bleeding, infection, or blood clots.
• Avoiding another scar on the uterus. If you are planning to have another baby in the future, scarring is important to think about. Each added scar on the uterus raises the risk of having problems in a future pregnancy, such as placenta previa or placenta accreta.
• A lower risk that the baby will have breathing problems after delivery.
• A quicker recovery.

What are the risks?

The most common risk is that a VBAC does not succeed, and then a C-section must be started in the middle of labour. A C-section is a major surgery and has risks such as infection, bleeding, and blood clots. The risk of infection is higher if you try to give birth through the vagina and then need a C-section.

The most serious risk of a VBAC is that a C-section scar (uterine scar) could come open during a trial of labour. If this happens, you will get an emergency C-section. The risk that a scar will tear open is very low during VBAC if you have just one low caesarean scar and your labour isn't started with medicine.

Is VBAC Right for You?

Whether a VBAC is right for you depends on if you have any risk factors (things that increase your risk) that could make it unsafe. It also depends on how likely it is that a VBAC will be successful for you. You'll need to talk about this with your healthcare provider or midwife.

Here are some things to think about when considering a VBAC.

Why would you have a VBAC?

• Your care provider has experience with VBAC.
• You want to experience a vaginal birth.
• You want to lower the chances that your baby will have breathing problems after delivery.
• You feel that the benefits of vaginal birth outweigh the small risk that the scar on your uterus may break open during labour. If a scar breaks open, it can be very dangerous for both you and your baby.
• You want to avoid another scar on the uterus. Each added scar can cause problems with the placenta during a future pregnancy.
• Your previous C-section was done because your baby was breech, or for a condition or situation (like high blood pressure or pre-eclampsia) that you do not have in your current pregnancy.

Why would you not be able to have a VBAC?

• Your care provider does not have a lot of experience supporting VBAC.
• Your hospital doesn't offer VBAC.
• Your labour is induced.
• Your labour is augmented (medicine given to make labour stronger once it has already started).
• You are at greater risk of your uterus tearing because:
  • The scar on your uterus is an inverted T or low vertical incision. This kind of scar doesn't usually allow a safe VBAC.
  • You have had a previous rupture of your uterus or if you have had major reconstruction surgery of your uterus.
  • Your previous cesarean was because of a difficult, non-progressing labour, which is called dystocia.
  • Your body mass index (BMI) is greater than 30.
  • You've had more than two caesareans.
  • You are carrying triplets or more.
• The likelihood is low that a VBAC will work for you. Your healthcare provider or midwife may use a special calculator to figure out how likely it is that a VBAC will succeed. But these calculators are not good at predicting whether or not you will have a successful labour.
• You have a placenta problem or another medical issue that could make a vaginal birth risky.
• Something happens during your pregnancy or labour that requires a caesarean. For example:
  • You develop a problem with your blood pressure.
  • Your baby isn't head-down or is breech (bottom-down) or sideways.
  • Your labour isn't progressing well.
  • Your baby is having problems.

Learn more

Watch

What To Expect

A trial of labour after caesarean, or TOLAC labour, is the same as normal labour. But you and the baby will be watched more closely. During early labour, you can be as active as you want. There are no specific limits for TOLAC until active labour starts. During the active part of labour, electronic fetal monitoring is used to watch for early signs of problems.

If you are doing a trial of labour and you've never had a vaginal birth, your labour will be like a first-time labour. This is also true if your previous caesarean was done early in labour.

Medicines for starting or strengthening a trial of labour

Some healthcare providers or midwives avoid the use of any medicine to start (induce) a trial of labour. That's because they are concerned that the uterus may break open (rupture). Other healthcare providers or midwives are comfortable with the careful use of oxytocin to start labour if the cervix is soft and dilating.

If your labour slows or stops progressing, your healthcare provider or midwife may use oxytocin to strengthen (augment) your contractions.

Pain medicine

As with most vaginal births, you can safely use pain medicine during labour.

Types of pain medicines used include:

• Local anesthesia. It numbs the small area where the medicine is injected.
• Epidural anesthesia. This type partly or fully numbs the lower part of your body.
• Intravenous (I.V.) anesthesia. This type partly relieves pain and helps you relax.

Learn more

Watch

Recovery

Vaginal birth after caesarean (VBAC) recovery is similar to recovery after any vaginal birth. After a vaginal birth, you and your baby most likely can go home within 24 to 48 hours. Recovery from a C-section requires 2 to 4 days in the hospital. You'll also need a time of limited activity as the incision heals.

The overall risk of infection is low for both vaginal and caesarean deliveries. Before you leave the hospital, you will get a list of signs of infection to watch for in the first few weeks after the birth.

After the birth, it'll be important to take good care of yourself—by resting when you can, having good support, and staying healthy. Consider asking someone to stay with you to help for a few days. At first, plan to limit your guests and how long they stay, so you can rest.

Watch