Vaginal Birth After Cesarean (VBAC)

If you had a cesarean delivery in a previous pregnancy and are now preparing for the birth of another child, you may consider talking to your physician or midwife about delivering your baby vaginally. Today, most women who have had cesarean births are encouraged to give birth through the vagina if no risk factors are present. For most women, the benefits of attempting vaginal birth outweigh the risks. In fact, most of these women have successful vaginal deliveries.

The old phrase "once a C-section always" is no longer true. In the past, the belief was that if a woman had delivered one baby by C-section, all other children had to be delivered the same way. Today many women can have vaginal deliveries after a previous C-section delivery. This is referred to as a vaginal birth after cesarean (VBAC). Attempting to have a vaginal birth after a previous cesarean section is called a trial of labor after cesarean (TOLAC).

There are several reasons to consider a vaginal birth after a previous cesarean delivery:

• Fewer risks of complications
• Shorter hospitalization
• Faster recovery time for the mother
• More involvement in the birth process

How to know if you’re a candidate for VBAC:

• You’ve had no more than two prior low-transverse C-section delivery
• You have no other uterine scars or ruptures
• Your pelvis is large enough to allow a vaginal delivery
• Your delivery is scheduled at a hospital with a physician, anesthesia and staff immediately available throughout labor to perform an emergent C-section, if it becomes necessary

However, ACOG (American College of Obstetrics and Gynecology) recommends that for some women, the risk of TOLAC/VBAC may not outweigh the risks, such as rupture of the uterus. For women with these complications, a second C-section may be recommended as a safer alternative:

• Women with high vertical or t-shaped incision on the uterus
• Women with a history of extensive uterine surgery
• Women with a small pelvis or delivering a large baby
• Those with medical problems or obstetric conditions, such as placenta previa or abruptio placenta
• Prior uterine rupture
• Women with more than two prior C-sections and no previous vaginal deliveries

TriHealth’s Board-Certified Physicians and Certified Nurse Midwives support TOLAC and VBAC when the situation is deemed safe for mother and baby. Please talk to your provider to see if they feel you are a candidate for vaginal birth following C-section.