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Vaginal birth after Cesarean Birth, or VBAC, is vaginal delivery of a baby after the mother has previously had a child by Cesarean birth.

What is the information for this topic?

Many women choose to try a vaginal delivery even if they have had a Cesarean birth before. The American College of Obstetricians and Gynecologists, or ACOG, has given these guidelines for successful VBAC:

• one or two Cesarean births in the past with a low-transverse incision, which is made across the lower part of the uterus
• a pelvis large enough to allow the baby to pass through
• no vertical uterine scars or history of past uterine rupture
• a maternity caregiver who can monitor active labor and perform an emergency Cesarean birth if needed
• anesthesia and staff as needed for an emergency Cesarean birth

There are several reasons to consider a vaginal birth after a previous Cesarean birth.

• A Cesarean birth is major surgery. It may cause bleeding, infection, a tear in the uterine wall, or a reaction to anesthesia.
• General anesthesia may be needed for a Cesarean birth. The mother may not be able to take part in the birth of her child.
• The healing of a large abdominal incision can take weeks.

However, other risk factors with vaginal delivery may make a Cesarean birth preferable.

• Some women fear labor pain during a vaginal delivery. There are many ways to ease the pain, but most pain medicines carry a small risk of side effects.
• A woman with a small pelvis and a large baby could have problems with a vaginal delivery.
• Twins or triplets may be in unusual positions in the uterus.
• The baby may have a breech presentation, which means the feet or buttocks come out first.
• The mother may have health problems, such as diabetes, preeclampsia, high blood pressure, or severe heart disease.

A new study has shown that the risk of rupturing the uterus during vaginal birth is more than three times higher among women who have had a Cesarean birth than those who have not. If labor is induced with medicines, the rate can increase 4.9 to 15 times higher.

However, the overall risk of uterine rupture is still very low. In the study, only roughly 90 women out of more than 20,000 VBAC mothers had a uterine rupture. This is well below 1%.

A woman should discuss her VBAC risk factors with her healthcare provider during prenatal visits.