VBAC (Vaginal Birth After Cesarean): Can You Really Have One?

For many women, being told they need a repeat cesarean after a previous one can feel like an unavoidable fate. But what if that’s not true? What if you actually can have a vaginal birth after a cesarean (VBAC)? The reality is that far more women are candidates for a VBAC than they’re led to believe. If you’ve had a prior C-section and are wondering about your options, let’s dive into the facts, risks, and benefits so you can make the best decision for you and your baby.

Why Choose a VBAC?

A successful VBAC comes with many benefits, including:

• No abdominal surgery – Avoiding another major operation means a lower chance of complications.

• Shorter recovery period – Vaginal births typically allow for quicker postpartum recovery.

• Lower risk of infection – Since there’s no surgical incision, the risk of infection is reduced.

• Less blood loss – Cesarean births involve more blood loss than vaginal births.

• Better long-term health outcomes – If you plan on having more children, avoiding multiple C-sections can reduce risks such as placenta accreta, bladder injury, and even hysterectomy.

Beyond these medical benefits, many women simply desire the experience of a vaginal birth, which can be an empowering and healing process after a previous C-section.

Understanding the Risks: Uterine Rupture vs. Multiple Cesareans

One of the biggest concerns surrounding VBAC is the risk of uterine rupture—when the scar from a previous C-section separates during labor. While this is a serious complication, let’s look at the numbers:

• The overall risk of uterine rupture for a trial of labor after cesarean (TOLAC) is 0.47%.

• If labor is induced with Pitocin, the risk rises to about 1.1%.

• If prostaglandins are used, it increases to 2%.

• Misoprostol induction carries the highest risk at 6%.

On the other hand, repeat cesareans carry their own significant risks—something that’s rarely discussed. One of the biggest dangers is placenta accreta, a life-threatening condition where the placenta grows too deeply into the uterine wall. The risk of placenta accreta increases with each C-section:

• 2nd cesarean: 0.31%

• 3rd cesarean: 0.57%

• 4th cesarean: 2.13%

• 5th cesarean: 2.33%

• 6th cesarean: 6.74%

Placenta accreta can lead to hemorrhage, hysterectomy, and even maternal death, with a 7% mortality rate.

Who is a Good Candidate for a VBAC?

VBAC is a great option for most women with a prior C-section. The main contraindications include:

• A classical (vertical) or inverted T-shaped uterine scar.

• A prior uterine rupture.

• Placenta previa (where the placenta covers the cervix).

• Transverse fetal position (where the baby is sideways in the womb).

  
  

Protective factors that can increase VBAC success and reduce the risk of uterine rupture include:

• Having a previous vaginal birth (before or after a C-section).

• Waiting at least 24 months between pregnancies.

• Spontaneous labor (labor that starts on its own without medical induction).

  
  

How to Navigate VBAC-Friendly vs. VBAC-Tolerant Providers

Not all doctors and hospitals are truly VBAC-friendly. Some providers claim to support VBACs but place unnecessary restrictions—like requiring an epidural or not allowing labor to progress naturally. This is why it’s crucial to interview your provider early in pregnancy and ask specific questions about their policies.

The Bottom Line: Informed Choice Matters

The decision between a VBAC and a repeat C-section is deeply personal, and you deserve complete, unbiased information to make the right choice for your body and baby. Many women who are told VBAC isn’t an option actually qualify, and when properly supported, VBAC success rates are high.

If you’re considering a VBAC, surround yourself with a supportive provider, a knowledgeable doula, and access to evidence-based childbirth education. Your body is capable, and you have options.

Looking for more guidance? My Natural Hospital Birth Course walks you through how to advocate for your VBAC, understand hospital policies, and make informed choices about your birth. Let’s get you the birth experience you deserve!