VBAC: Know the pros and cons

Many women are candidates for vaginal birth after cesarean (VBAC). In 2013, the success rate for women in the U.S. who attempted a trial of labor (TOLAC) after one previous cesarean was 70%.

Still, the choice to pursue VBAC or schedule a repeat C-section can be difficult. Here's insight on how to make the decision.

Why consider VBAC?

Compared with having another C-section, a vaginal delivery involves no surgery, none of the possible complications of surgery, a shorter hospital stay and a quicker return to normal daily activities. VBAC might also be appealing if you want to experience vaginal childbirth.

It's important to consider future pregnancies, too. If you're planning for more pregnancies, VBAC might help you avoid the risks of multiple cesarean deliveries, such as placental problems.

What are the risks of VBAC?

While a successful VBAC is associated with fewer complications than an elective repeat C-section, a failed trial of labor after a C-section is associated with more complications, including a uterine rupture. Uterine rupture is rare, happening in less than 1% of women who attempt a trial of labor after cesarean. However, uterine rupture is life-threatening for you and your baby. During a uterine rupture, the cesarean scar on the uterus breaks open. An emergency C-section is needed to prevent life-threatening complications. Treatment might involve surgical removal of the uterus (hysterectomy). If your uterus is removed, you won't be able to get pregnant again.

Who's eligible for VBAC?

VBAC eligibility depends on many factors. For example:

• What type of uterine incision was used for the prior C-section? Most C-sections use a low transverse incision. Women who have had a low transverse or low vertical incision are usually VBAC candidates. If you've had a prior high vertical (classical) incision, VBAC isn't recommended because of the risk of uterine rupture.
• Have you ever had a uterine rupture? If so, you're not a candidate for VBAC.
• Have you had other surgeries on your uterus? If you've had other uterine surgeries, such as for fibroid removal, VBAC isn't recommended due to the risk of uterine rupture.
• Have you had previous vaginal deliveries? A vaginal delivery at least once before or after your prior C-section increases the probability of a successful VBAC.
• How many C-sections have you had? Many health care providers won't offer VBAC if you've had more than two prior C-sections.
• When did you last give birth? The risk of uterine rupture is higher if you attempt VBAC less than 18 months after your previous delivery.
• Do you have any health concerns that might affect a vaginal delivery? A C-section might be recommended if you have placental problems, your baby is in an abnormal position, or you're carrying triplets or higher order multiples.
• Where will you deliver the baby? Plan to deliver at a facility equipped to handle an emergency C-section. A home delivery isn't appropriate for VBAC.
• Will you need to be induced? Having labor induced decreases the likelihood of a successful VBAC.

How does labor and delivery during VBAC differ from labor and delivery during a routine vaginal birth?

If you choose VBAC, when you go into labor you'll follow a process similar to that used for any vaginal delivery. However, your health care provider will likely recommend continuous monitoring of your baby's heart rate and be prepared to do a repeat C-section if needed.

What other advice do you offer women who are considering VBAC?

If you're considering VBAC, discuss the option, your concerns and your expectations with your health care provider early in pregnancy. Make sure he or she has your complete medical history, including records of your previous C-section and any other uterine procedures. Your health care provider might calculate the likelihood that you'll have a successful VBAC.

Also, plan to deliver your baby at a facility that's equipped to handle an emergency C-section. Continue discussing the risks and benefits of VBAC throughout pregnancy, especially if certain risk factors arise.

Above all, try to stay flexible. The circumstances of your labor could make VBAC a clear choice or, after counseling, you and your health care provider might decide that a repeat C-section would be best after all.