Vaginal Birth After Cesarean Delivery

     A cesarean birth is the delivery of a baby through an incision (cut) made in the mother's abdomen and uterus.  It was once thought that if a woman had one cesarean birth, all other children she had should be born the same way.  Today, many women who have had a cesarean delivery can safely give birth through the vagina.  This is called vaginal birth after cesarean  (VBAC) delivery.  VBAC is an option for many women.  There are some risks, though. 

 

   

REASONS TO TRY VBAC

     Of women who try VBAC, about 60%-80% succeed and are able to deliver vaginally.  Other women may try VBAC but need to switch to a cesarean birth.  There are some good reasons to try VBAC.  Advantages to a vaginal birth include:

	No abdominal surgery
	Shorter hospital stay
	Lower risk of infection
	Less need for blood transfusions
	Faster recovery

 

 

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 birth.  For cesarean birth, one incision is made in your abdomen and another in your uterus.  Any incision makes a scar.  Certain types of incisions have a higher risk of the scar tearing during the next birth.  You can't tell  what type of scar you have in your uterus by looking at the scar on your skin.  Your medical records should show which type of incision was used.  There are three types of incisions:

	Low transverse-A side-to-side cut made across the lower, thinner part of the uterus
	Low vertical-An up-and-down cut made in the lower, thinner part of the uterus
	High vertical (or classical)-An up-and-down cut made in the upper part of the uterus

    Women with high vertical (classical) scars on the uterus have a higher risk of rupture.  Women who have had more than one cesarean delivery also may have an increased risk of rupture.  Although it does not occur often, a rupture of the uterus 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.

 

 

OTHER FACTORS TO CONSIDER

Other factors may affect whether VBAC is an option for you.  It may not be a good choice in some cases:

	Small pelvis/large baby-the baby is too large to pass safely through your pelvis during delivery
	Problems for the baby-there are signs that the baby may have problems during labor or vaginal delivery
	Problems with the placenta-includes abruptio placenta or placenta previa
	Certain conditions-includes certain serious medical or obstetric conditions

     If problems arise or worsen during labor, or if labor is taking too long to progress, cesarean delivery may be needed.  The facility where you deliver your baby should be equipped to handle an emergency cesarean delivery.  There is a higher risk for infection in the mother and baby in women who try VBAC and then give birth by cesarean. 

 

 

FINALLY...

     VBAC can be a safe option for many women.  Depending on your needs, VBAC may a good choice for you.  No labor or delivery is risk free.  When considering VBAC, you need to know the risks.  Weigh those risks against the benefits before you decide.  Your doctor will guide your decision to do what's best for you and your baby. 

 

 

 

ACOG PATIENT EDUCATION