Patient education: Vaginal birth after a cesarean (The Basics)

What is a vaginal birth after a cesarean? — This is when a person gives birth to a baby through the vagina (figure 1) after they had a cesarean birth in the past. Cesarean birth means having surgery to give get the baby out of the uterus (figure 2). The surgery is sometimes called a "c-section."

A vaginal birth after a cesarean is called a "VBAC" for short. Many people can safely have a VBAC.

If you have had a cesarean birth in the past, you usually have a choice about how to give birth to your other babies. You can either:

●Plan to go through labor and try to have a vaginal birth – Doctors call this a trial of labor after cesarean, called "TOLAC" for short. A trial of labor might work and end with a VBAC. But sometimes it doesn't work, and you need to have another cesarean birth.

●Plan to have a cesarean birth before labor starts

What are the benefits of a VBAC? — The benefits of a VBAC include:

●A shorter stay in the hospital after giving birth

●Less pain after the birth and a shorter recovery time (usually)

●Fewer problems after the birth – People who have a cesarean birth have a higher chance of getting a fever, infection, blood clot in the legs, or needing blood.

What problems might happen with a trial of labor? — Different problems can happen with a trial of labor. But the problem doctors and midwives worry about most is something called "uterine rupture." This is when the uterus tears where it was cut during past surgery. This is rare, but if it does happen, it is an emergency, because it can be dangerous for you and your baby. If it happens, you will need surgery right away to get the baby out and fix the tear, if possible.

Also, sometimes, a trial of labor doesn't work. The labor might not progress normally, and you might need to have a cesarean birth anyway. This can be upsetting and stressful.

What if I want to try and have a VBAC? — If you want to try and have a VBAC, let your doctor or midwife know. Based on your individual situation, they will help you decide whether a trial of labor is a good choice for you.

In general, a trial of labor has the highest chance of working when:

●You had a vaginal birth in the past (in addition to having a cesarean birth).

●The first cesarean birth happened because your baby was in a breech position. This is when a baby's legs or buttocks (and not head) are closest to the vagina (figure 3).

In some cases, a trial of labor is not recommended. This happens when:

●The uterus was not cut open in the usual way during the previous cesarean birth.

●A uterine rupture (tear) happened in a past pregnancy.

●A vaginal birth isn't safe for you or your baby.

If you want to have a trial of labor, you will need to be in a hospital or center where surgery could be done right away if needed.

More on this topic

Patient education: Cesarean birth (The Basics)
Patient education: Labor and childbirth (The Basics)
Patient education: How to tell when labor starts (The Basics)

Patient education: C-section (cesarean delivery) (Beyond the Basics)