What is vaginal birth after cesarean (VBAC)?

VBAC refers to vaginal delivery of a baby after a previous pregnancy was delivered by cesarean delivery.

In the past, pregnant women who had one cesarean delivery would automatically have another. But research shows that, for many women who had prior cesarean deliveries, attempting to give birth vaginally—called a trial of labor after cesarean delivery (TOLAC)1—and VBAC might be safe options in certain situations.

In fact, NICHD research shows that among appropriate candidates, about 75% of VBAC attempts are successful.2 A 2010 NIH Consensus Development Conference on VBAC evaluated available data and determined that VBAC was a reasonable option for many women.3

NICHD-supported researchers also developed a way to calculate a woman's chances of a successful VBAC.4 Access the calculator. Please note that this calculator only determines the likelihood of successful VBAC; it does not guarantee success.

Women should discuss VBAC and TOLAC with their health care providers early in pregnancy to learn whether these options are appropriate for them. Providers are encouraged to discuss plans for VBAC or refer women to a facility that can support VBAC when it is medically safe to consider.5

When is VBAC appropriate?

VBAC may be safe and appropriate for some women, including those:6

  • Whose prior cesarean incision was across the uterus toward its base (called a low-transverse incision)—the most common type of incision. Note that the incision on the uterus is different than the incision on the skin.
  • With two previous low-transverse cesarean incisions
  • Who are carrying twins
  • With an unknown type of uterine incision

Benefits of VBAC include:1,6

  • No abdominal surgery
  • A lower risk of hemorrhage and infection compared with a C-section
  • Faster recovery
  • Potential to avoid the risks of many cesarean deliveries, such as hysterectomy, bowel and bladder injury, blood transfusion, infection, and abnormal placenta conditions
  • Greater likelihood of being able to have more children in the future

If labor fails to progress or if there is another problem, a woman may need a C-section after trying TOLAC. Most risks associated with C-section after TOLAC are similar to those associated with choosing a repeat cesarean. They include:1,7

  • Uterine rupture
  • Maternal hemorrhage and infection
  • Blood clots
  • Need for a hysterectomy

Citations

  1. American College of Obstetricians and Gynecologists. (2011). FAQ: Vaginal birth after cesarean delivery: Deciding on a trial of labor after cesarean delivery. Retrieved February 16, 2017, from https://www.acog.org/Patients/FAQs/Vaginal-Birth-After-Cesarean-Delivery external link
  2. Landon, M. B., Leindecker, S., Spong, C. Y., Hauth, J. C., Bloom, S., Varner, M. W., et al. (2005). The MFMU Cesarean Registry: Factors affecting the success and trial of labor following prior cesarean delivery. American Journal of Obstetrics and Gynecology, 193, 1016–1023.
  3. National Institutes of Health Consensus Development Conference Panel. (2010). National Institutes of Health Consensus Development Conference statement: Vaginal birth after cesarean: New insights March 8–10, 2010. Obstetrics & Gynecology, 115(6), 1279–1295.
  4. Grobman, W. A., Lai, Y., Landon, M. B., Spong, C. Y., Leveno, K. J., Rouse, D. J., et al.; National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network (MFMU). (2007). Development of a nomogram for prediction of vaginal birth after cesarean delivery. Obstetrics and Gynecology, 109, 806–812
  5. Hauk, L.; American Academy of Family Physicians. Planning for labor and vaginal birth after cesarean delivery: Guidelines from the AAFP. (2015). American Family Physician, 91(3), 197–198. Retrieved February 23, 2017, from http://www.aafp.org/afp/2015/0201/p197.html external link
  6. American College of Obstetricians and Gynecologists. (2010; reaffirmed 2017). ACOG practice bulletin no. 115: Vaginal birth after previous cesarean delivery. Obstetrics and Gynecology, 116(2 Part 1), 450–463. Retrieved August 7, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/20664418
  7. Armstrong, C. (2011). ACOG updates recommendations on vaginal birth after previous cesarean delivery. American Family Physician, 83(2), 215–217. Retrieved February 23, 2017, from https://www.aafp.org/afp/2011/0115/p214.html external link
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