Vaginal Birth After Cesarean (VBAC): Is Vbac Right For You

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Is VBAC Right for You?

If your current pregnancy and health history are considered low-risk, you are a good candidate for a successful vaginal birth after cesarean (VBAC). However, you may have one or more conditions that lower your chances of a successful trial of labor and increase your risk of complications. As you and your health professional decide whether VBAC is right for you, consider the following information.

You are a good candidate for a successful trial of labor and VBAC if you have had one cesarean birth using a low transverse incisionAND:¹

Your baby is normal in size and in the head-down (vertex) position.
Labor has started on its own (spontaneously) and your cervix is dilating well.
No medical reason exists for a cesarean delivery with this pregnancy. (Possible medical reasons for having a cesarean include placenta previa, breech position, narrow pelvis, triplets or more, and active genital herpes.)
You want to have a trial of labor and a vaginal delivery.
You can deliver in a hospital that offers VBAC and has the ability to do a rapid emergency C-section.

Should I have a VBAC trial of labor after a previous cesarean?

As with a first-time childbirth, even if you are a good candidate for a successful VBAC, there is no guarantee that you will give birth vaginally and without complications.

You and your doctor may consider a VBAC if: ¹

You have had two cesarean births using low transverse incisions AND a vaginal delivery. (The risk of uterine rupture increases with each additional scar. But a history of at least one vaginal birth greatly lowers this risk in women with two cesarean scars.)
The type of incision used for your prior cesarean is unknown (previous surgery records are not available), but your health professional can judge that it is a low transverse scar based on why you had a cesarean section.
You are carrying twins and they are positioned properly inside your uterus.
You have delivered vaginally and by cesarean before and are now carrying a very large fetus with an estimated weight of to . The larger the fetus, the less chance there is of delivering vaginally.
Labor has not started on its own, but your cervix is soft and partially dilated. If you have a medical need to deliver right away, your doctor may carefully use oxytocin (Pitocin) to start labor. Your doctor may also place a thin tube with a small balloon into the cervix. This can soften the cervix without raising the chance of uterine rupture.

VBAC is not considered safe if you have: ¹

No access to a hospital that can offer close monitoring and is equipped to handle an emergency cesarean delivery.

You are not a good candidate for VBAC if you have factors that increase the risk of uterine rupture, including:¹

Labor that has not started on its own and a cervix that is closed and firm. This is especially true if you have never had a vaginal delivery. In this case, starting labor with medicine, such as misoprostol (Cytotec), raises the risk of uterine rupture during VBAC. (If oxytocin is used carefully to help a slow labor, it is less likely to increase your uterine rupture risk.)^1,² Some doctors place a thin tube with a small balloon into the cervix. This can soften the cervix without raising the chance of uterine rupture.
A vertical (classical) uterine incision that reaches above the lower uterus.
Two or more cesarean scars and no previous vaginal delivery.¹
A cesarean section within the past 2 years.³
A single-layer closure (rather than a double-layer closure) of your previous cesarean section.⁴
Previous uterine surgery, such as removal of a uterine growth (fibroid) that has cut deeply into the uterus.
A narrow (contracted) pelvis, as determined during your last delivery.
A breech fetus, positioned with the feet or buttocks down in the uterus.
Triplets or more during this pregnancy.
A medical reason for a cesarean, such as active genital herpes or placenta previa, in this pregnancy.

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Last updated:	April 20, 2007
Author:	Kathe Gallagher, MSW
Reviewed By:	Joy Melnikow, MD, MPH - Family Medicine, Kirtly Jones, MD - Obstetrics and Gynecology
Editors:	Kathleen M. Ariss, MS, Pat Truman

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