Written By: Women and Infants on December 31, 1969
It is a common question for OBGYNs: Can I have a vaginal birth after I’ve had a cesarean section. In this article you will find information on your options and any risks involved.
What are my options for giving birth if I have had a prior cesarean birth?
If you have had a cesarean birth in the past, there are three (3) possibilities for the birth of your next baby:
- You can go into labor and have a vaginal birth, which is called a vaginal birth after cesarean (VBAC).
- You can go into labor but need another cesarean.
- You can choose to have another cesarean, which is called an elective repeat cesarean birth.
What are the benefits of having a VBAC?
Overall, your risk of having complications is less if you give birth vaginally.
- You will likely spend less time in the hospital
- Recover faster - with less pain.
- Your baby has less chance of breathing problems shortly after a vaginal birth when compared to babies born by cesarean.
What are the risks of attempting a VBAC?
You have a higher chance of uterine rupture (uterus opening at the old scar), which is dangerous for your baby.
- Uterine rupture is very rare – happening to about 8 in every 1,000 women in labor who had a previous cesarean.
- If your uterus does rupture, there is a higher chance your baby will die. This means that in 10,000 women who had a cesarean and try to have a VBAC, two (2) babies will die.
What are the benefits of having another cesarean birth?
You can schedule when your birth will likely happen. You will also know what to expect from surgery.
What are the risks of having another cesarean birth?
Overall, your risk of complications is higher if you have a repeat cesarean.
- You are more likely to have problems with surgery like infection, bleeding, and damage to other organs, or to have a blood clot after surgery.
- You are more likely to have problems with your placenta in future pregnancies. This can lead to severe complications like bleeding, hysterectomy, and death.
In the United States, 13 out of 100,000 women who have a cesarean and 4 out of 100,000 women who have a vaginal birth will die from a complication during labor or birth.
Death is a very rare outcome.
Are there reasons I should not attempt a VBAC?
If you have any of the following, it is safest for you to have another cesarean:
- The incision that was made on your uterus is vertical - This is rare and only likely if your cesarean was an emergency. If the uterine incision is vertical, you have a higher chance of having a uterine rupture. The incision on your abdomen was most likely horizontal. The abdominal scar you see on your skin does not tell you if the uterine scar is horizontal or vertical.
- If you have had more than one cesarean in the past - This may put you at a higher chance of having a uterine rupture and a lower chance of having a successful VBAC.
- You had a previous uterine rupture or major surgery on your uterus.
- You have a problem during this pregnancy making it safer to have a c-section - such as placenta previa (placenta covering the opening of your cervix).
What is the chance that I will have a successful VBAC?
Overall, about 3 out of 4 women who try to have a VBAC will have a successful vaginal birth. Some things in your medical history affect your chance of success.
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More Likely to Have a Successful VBAC
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Less Likely to Have a Successful VBAC
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- The reason you had your first cesarean is unlikely to happen again. For example, your baby was in breech presentation (bottom first), you had twins, or your baby did not tolerate labor.
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- The reason you had your first cesarean is likely to happen again. For example, your cervix didn't dilate to 10 centimeters after you were in labor or your baby did not come down in your pelvis during pushing.
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- You have had a vaginal birth in the past either before or after your cesarean.
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- You have had more than one cesarean in the past
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- You go into labor on your own.
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- Your labor must be induced.
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- You have the baby before your due date.
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- You have the baby after your due date.
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- Your baby weighs more than 8 pounds, 13 ounces.
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How do I choose if a VBAC or repeat cesarean is right for me?
Choosing your method of birth is an important and very personal decision. Before you make your decision, speak with your health care provider to learn how high your chance of having a VBAC is if you have labor, and how high your risk of uterine rupture is. Your chance of VBAC success and uterine rupture will depend on what happened during your last labor.
You and your family can also discuss how you feel about the following reasons to have a VBAC or repeat cesarean.
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Some Reasons to Try VBAC
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Some Reasons to Have a Repeat Cesarean
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- You plan to have more children after this pregnancy.
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- It is important for you to know the date your baby will be born.
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- You want a shorter hospital stay.
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- It is important to you to avoid having an emergency cesarean.
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- The risk of uterine rupture is low, and you really want to have a vaginal birth.
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- It is important to you to know exactly what to expect during birth.
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What can I expect if I choose to attempt a VBAC?
It is safest to have a VBAC in a hospital, so you and your baby can be monitored during labor. Signs of distress in the baby are usually the first sign of uterine rupture. Because of this, you will have continuous fetal heart rate monitoring during labor. An IV will be placed so it is available in case there is an emergency. You should be able to have any type of pain medicine you would like.
