Today, doctors know that many women who have had a cesarean delivery can later safely give birth though the vagina. This is called vaginal birth after cesarean (VBAC) delivery. VBAC can be a safe option for many women. However, it is not the right choice for all women, and there are some risks. This pamphlet will explain:

Why you may want to think about trying VBAC What risks are involved Whether VBAC is right for you

VBAC can be an option for many women. Depending on your needs, VBAC may be a good choice for you.

Reasons to Consider VBAC

Of women who try VBAC, 60–80% succeed and are able to give birth vaginally. The success rate varies depending on the reason for the previous cesarean delivery. Other women may try VBAC but need to switch to a cesarean delivery. There are some reasons why a woman may want to try VBAC over cesarean delivery:

• No abdominal surgery
• Shorter hospital stay
• Lower risk of infection
• Less blood loss
• Less need for blood transfusions

VBAC has risks as well as benefits. With VBAC, there is a risk that the cesarean scar may tear during delivery. There also is a risk that the uterus will tear (rupture). Although a rupture of the uterus is rare, it is serious and may be harmful to you or your baby. If your doctor thinks you are at high risk for rupture of the uterus, VBAC should not be tried.

Sometimes, when a woman chooses VBAC, she may have to switch to a cesarean delivery during the course of labor. This can happen if problems arise without warning or worsen during childbirth. If problems arise, you may need an emergency cesarean delivery. There is a higher risk of infection for the mother and baby in women who try VBAC and then give birth by cesarean delivery.

Is VBAC Right for You?

In deciding if you can try VBAC, a key factor is the type of incision you had in your uterus for your previous cesarean delivery. Some types are more likely to rupture than others.

For cesarean birth, one incision is made in your abdomen and another incision is made in your uterus. Any incision makes a scar. You cannot tell what kind of incision you had in your uterus by looking at the scar on your skin. Your doctor should be able to tell which kind of incision you had by looking at your medical records, if they are available. If your doctor does not know what type of incision you had, you may not be a candidate for VBAC.

There are three types of incisions:

1. Low transverse—A side-to-side cut made across the lower, thinner part of the uterus
2. Low vertical—An up-and-down cut made in the lower, thinner part of the uterus
3. High vertical (also called "classical")—An up-and-down cut made in the upper part of the uterus

Other Factors to Consider

Other factors may affect whether VBAC is an option for you. These include problems with the placenta, problems with the baby, or certain medical conditions during pregnancy.

For example, a woman can still try VBAC when her pregnancy continues past her due date. However, vaginal birth after cesarean delivery may not be a good option if the doctor decides that there is a need to induce labor (use drugs to help labor begin).

Vaginal birth after cesarean delivery is not performed in some hospitals. The hospital or other facility where the baby is delivered should be equipped to handle an emergency cesarean delivery. Talk to your doctor to find out what is best for you.

In many ways, women who attempt VBAC will go through some of the same things that other women experience. For instance, fetal monitoring will be used to check on the health of the baby, and an epidural can be given for pain relief.

Finally...

VBAC can be an option for many women. Depending on your needs, VBAC may be a good choice for you.

No labor or delivery is risk-free. Both repeat cesarean births and VBAC have risks and benefits. When considering VBAC, you need to know the risks. Weigh those risks against the benefits before you decide. Your doctor will help guide your decision to do what is best for you and your baby.

Glossary

Placenta: Tissue that provides nourishment to and takes away waste from the fetus.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

This Patient Education Pamphlet was developed under the direction of the Committee on Patient Educationof the American College of Obstetricians and Gynecologists. Designed as an aid to patients, it sets forth current information and opinions on subjects related to women's health. The average readability level of the series, based on the Fry formula, is grade 6–8. The Suitability Assessment of Materials (SAM) instrument rates the pamphlets as "superior." To ensure the information is current and accurate, the pamphlets are reviewed every 18 months. The information in this pamphlet does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations taking into account the needs of the individual patient, resources, and limitations unique to the institution or type of practice may be appropriate.

Copyright © October 2005 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

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