About Vaginal Birth After Cesarean

Compiled from “Quick Facts” at VBACFacts.com 

After a cesarean, most women have two choices for future births: a vaginal birth after cesarean (VBAC) or a repeat cesarean section (RCS). There is a  lot of misinformation about these two options. 

Per the American College of Obstetricians and Gynecologists, VBAC is a  reasonable and appropriate choice for most women with one prior cesarean and for “some women” with two prior cesareans. Being pregnant with twins, going over 40 weeks, having an unknown or low vertical scar,  or suspecting a “big baby” should not prevent women from planning a  VBAC. 

VBAC is successful 75% of the time. Successful VBACs have lower maternal complication rates than planned repeat cesareans which have lower rates than VBACs that end in a cesarean. 

Permitting labor to begin naturally after one prior low transverse (“bikini cut”) cesarean carries a 0.4% risk of rupture which can increase upon labor augmentation or induction. These rates are similar to other serious obstetrical emergencies such as placental abruption, cord prolapse, and shoulder dystocia. 

Cesarean risks, including placenta accrete, hysterectomy, blood transfusion, and ICU admission, increase with each surgery; whereas, after a successful VBAC, the future risk of uterine rupture, uterine dehiscence,  and other labor-related complications decrease.  

Of the women interested in VBAC, 57% are unable to find a supportive care provider or hospital. This is due primarily to the 1999 ACOG recommendation that a doctor be “immediately available “ to perform a  cesarean, yet they provided no clear definition or standard for where the obstetrician and/or anesthesiologist should be. 

As a result, hospitals developed their own definitions producing differing  VBAC protocols and requirements. The most severe variety was the institution of formal VBAC bans in 78% of all American hospitals and de facto bans in an additional 21%. The 2010 ACOG guidelines addressed these bans and confirmed: “restrictive VBAC policies should not be used to force women to undergo a repeat cesarean delivery against their will.” 

Hopefully, VBAC will become a viable option for the many women who desire it.