What Is a VBAC?

The pros and cons of a vaginal birth after cesarean

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Vaginal birth after cesarean (VBAC) refers to the vaginal delivery of a baby after a previous pregnancy was delivered by cesarean delivery.

The rate of cesarean delivery has increased to more than 31% in the United States, and for many years it was believed that pregnant people who had one cesarean delivery would automatically need to have another.

But research has shown that for many people who had prior cesarean deliveries, attempting to give birth vaginally—called a trial of labor after cesarean delivery (TOLAC)—leading to VBAC might be a safe option in certain situations.

Mixed race doctor examining pregnant patient's belly

Ariel Skelley/Getty Images

How Successful Are VBACs?

Research by the National Institute of Child Health and Human Development shows that among appropriate candidates, around 75% of VBAC attempts are successful.

People who deliver vaginally after a previous cesarean are less likely than people who have repeat cesareans to experience birth-related morbidity such as:

  • Blood transfusion
  • Ruptured uterus
  • Unplanned hysterectomy
  • Admission to the intensive care unit

Read on to learn about the benefits and risks of attempting to give birth vaginally after delivering by cesarean section (c-section).

What Are the Benefits of a VBAC?

A c-section, which is major surgery, has risks beyond those of vaginal childbirth. While a c-section is sometimes clinically necessary, a vaginal birth should be considered for many reasons.

The advantages of VBAC over a cesarean birth include:

  • No abdominal surgery
  • Shorter recovery time
  • Lower risk of infection and other complications, such as problems with the placenta, called placenta previa and placenta accreta
  • Less risk of complications from repeated surgeries, including scarring or injuries to the bowel or bladder, if you’re planning on having a lot of children

What Are the Risks of a VBAC?

One rare but serious risk with VBAC is that the cesarean scar on the uterus may rupture (break open). If this happens, it can very quickly place the baby in jeopardy, and an emergency c-section will be necessary.

After cesarean delivery, you will have a scar on your skin and a scar on your uterus. Some uterine scars are more likely than others to cause a rupture during VBAC. The type of scar depends on the type of cut in the uterus:

  • Low transverse, in which the incision is made from side to side across the lower, thinner part of the uterus. It's the most common type of incision and carries the lowest risk of future rupture.
  • Low vertical, in which an up-and-down cut is made in the lower, thinner part of the uterus. It has a higher risk of rupture than a low transverse incision.
  • High vertical, or “classical,” in which an up-and-down incision in the upper part of the uterus sometimes is done for very preterm cesarean deliveries. It has the highest risk of rupture.

How Do I Know What Type of Uterine Incision I Have?

You cannot tell what kind of cut was made in the uterus by looking at the scar on the skin. Medical records from the previous delivery should include this information.

Am I a Good Candidate for a VBAC?

For many, the chances of achieving a vaginal birth after having had a c-section are good, according to the American Academy of Family Physicians, provided they meet certain criteria.

As long as your doctor agrees, you are likely a good candidate for VBAC if:

  • You have undergone one prior c-section with a low transverse uterine incision. Some locations may allow you to have a VBAC even if you have undergone two prior c-sections with a low transverse uterine incision.
  • You have previously had a vaginal delivery—one large-scale study found the success rate for VBAC in people who had a previous vaginal birth was as high as 86.7%.
  • You have no other conditions that would normally require a cesarean, such as placenta previa.
  • The reason you had a prior c-section was because the baby was breech.
  • You have discussed the risks and benefits of attempting a vaginal birth with your doctor and understand them.
  • You are having your baby in a hospital or other facility where an emergency c-section can be performed if necessary.

Can I Plan for a VBAC Home Birth?

It’ll be recommended that you give birth in a hospital because you’d have immediate access to a c-section and on-site blood transfusion facilities if you needed them.

When Is a VBAC Not Recommended?

On some occasions, VBAC is not advisable and an elective repeat cesarean birth is a safer choice. These include:

  • You have had a previous uterine rupture.
  • You have had previous uterine surgery, such as fibroid removal.
  • You have had a high vertical uterine incision (classical cesarean).
  • You have other pregnancy complications that require a cesarean birth, such as a breech presentation.

Preparing for a VBAC

If you've previously had a c-section and you're pregnant, discuss your concerns and expectations with your healthcare provider. Make sure they have your complete medical history, including records of your previous c-section and any other procedures. Your healthcare provider might use your medical history to calculate the likelihood that you'll have a successful VBAC.

Also, plan to deliver your baby at a facility that offers VBAC and is equipped to handle an emergency c-section. Continue discussing the risks and benefits of VBAC throughout pregnancy, especially if your pregnancy becomes "high risk" due to high blood pressure or diabetes for instance.

If you choose VBAC, when you go into labor you'll follow similar processes that are used for any vaginal delivery, but you will likely be monitored more closely. Your healthcare provider will likely recommend continuous monitoring of your baby's heart rate and be prepared to do a repeat c-section if needed.

What Happens If Things Change During Labor?

If you have chosen to try a VBAC, things may happen during labor that alter the balance of risks and benefits. If circumstances change and either you or your baby are in danger, your healthcare provider may recommend surgical intervention.

The reverse also may be true. For example, if you have planned a cesarean delivery but go into labor before your scheduled surgery, it may be best to consider VBAC if you are far enough along in your labor and your fetus is healthy.

A Word From Verywell

When you become pregnant after a cesarean birth, you will need to discuss birthing options with your healthcare provider. It is important to have this conversation as early in the pregnancy as possible, particularly if your goal is to give birth vaginally.

In general, most people who meet the criteria and attempt a TOLAC will have a successful vaginal delivery. But not all providers, hospitals, and birthing centers offer VBAC. Talk to your provider to see if VBAC is available where you’re planning to have your baby.

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Article Sources
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  5. American Academy of Family Physicians. Clinical practice guideline planning for labor and vaginal birth after cesarean. Updated 2019.