Planning Your Next Birth After a C-Section

If you had a C-section with your last birth, you now have two choices as to how to give birth to your new baby. Some women plan to have another C-section (called an elective or planned repeat cesarean birth), while others plan to have the baby vaginally (called a vaginal birth after cesarean, or VBAC).

Making the choice about how your baby is born is something you have to decide on your own. It can take time to understand what you want, the needs of your family, and the risks and benefits of each option.

• A successful VBAC (meaning you give birth vaginally) has the least amount of risk for mom and baby.
• A repeat C-section (meaning you planned to have a C-section all along) has a risk that is somewhere in the middle.
• An unsuccessful VBAC, meaning you tried to give birth vaginally but ended up needing a C-section, carries a higher risk.

For many women, VBAC is a safe option and their chance of having a successful vaginal birth is about the same as a woman having her first baby.

Benefits of Vaginal Birth After Cesarean

Everyone has their own reasons for planning a VBAC. Some common reasons are:

• To avoid having a major abdominal surgery and the risks associated with surgery
  • Quicker recovery and a shorter hospital stay
  • Lower risk of infection, blood clots, or postpartum fever
• To lower the risk that the baby has breathing problems after birth
• To get to hold the baby (and potentially start breastfeeding) sooner after they are born
• To lower the risk, during future pregnancies, of having problems with how the placenta attaches
• To increase the chances of successfully giving birth vaginally in future pregnancies

Risks of Vaginal Birth After Cesarean

A VBAC can be very safe, but there are some risks. The main ones are:

• Increased chance of infection, if you end up having a C-section after laboring and attempting to give birth vaginally
• Small risk that the scar from your C-section could tear open during labor (called uterine rupture). If a uterine rupture occurs, there is a 1 in 1,000 chance that your baby will have a brain injury or die.

The chance you will have a uterine rupture is less than 1 in 100 (meaning that for every 100 women who have a VBAC, one has a rupture). However, if a uterine rupture occurs, you will need an emergency C-section.

There is also a higher chance that your uterus will have to be removed to stop heavy bleeding (called an emergency hysterectomy). If this happens, you will not be able to get pregnant again. 

Ensuring That You Are Supported and Safe

Your safety is the most important thing when deciding whether or not to have a VBAC. Whatever you choose, our highly qualified team of nurses, midwives, and doctors work together to ensure the safety of you and your baby.

• Our recommendations for your care during your pregnancy and delivery are based on the best research available.
• Childbirth education classes are available at the hospital multiple times a month. Knowing what to expect increases your chances of success!
• If you ask for one during a prenatal appointment, one of BMC’s labor and delivery doulas (Birth Sisters) can be present during your labor, in addition to your support person. Doulas are well trained in coaching people through labor and delivery, and feeling supported can decrease your stress and make laboring a smoother process.
• If you do need a repeat C-section, surgeons and anesthesia doctors are always available in the hospital.

What Can You Expect During Your Hospital Stay?

You will be asked to sign a consent form stating that you understand the risks and benefits of trying VBAC, and that you want to try to have a vaginal birth.

You will meet the anesthesiologist to discuss whether you want an epidural or not. Your options for pain medication during labor are not different because you had a previous C-section.

If you have been laboring but your cervix is not opened very much, or if your healthcare team recommends that you start labor early (usually because there is some other health problem for you or the baby), a cervical balloon may be placed in your cervix to help open it, or you may be given pitocin through an IV line to start or strengthen your contractions. 

Your contractions and the baby’s heart rate will be monitored the entire time you are in labor.

When Is VBAC Likely to Be Successful?

You’re most likely to have a successful VBAC if:

• Your hip bones are typically shaped (your previous C-section was done because of something besides a problem with your hip structure)
• You have not had more than two previous C-sections
• You’ve had a vaginal birth before
• You are not overweight or obese
• You are less than 40 weeks pregnant
• Your baby’s weight is estimated to be less than 8 pounds, 13 ounces
• Your labor starts on its own
• When you come to the hospital, you are in active labor (you are already having strong contractions and your cervix is opening)
• You have good support and access to pain control during your labor 

When Is VBAC Less Likely to Be Successful?

You may be less likely to have a successful VBAC if:

• You are age 35 or older
• You have the same medical or anatomical problem that led to your previous C-section
• You’ve never had a vaginal birth
• You are overweight or obese
• Your baby’s weight is estimated to be more than 8 pounds, 13 ounces
• You are in labor less than 18 months since your last C-section
• You need medication to begin labor
• You are admitted to the hospital while you are in early labor (your contractions are not too strong and your cervix is not open very much)
• You do not have good support or your pain is not well-controlled during labor

Advice for Getting to a Successful VBAC

• Select a prenatal provider who supports your decision to try VBAC.
• Attend childbirth education classes.
• Have a good support person or a trained doula (Birth Sister)—or both—present at your labor.
• Get regular exercise and have a healthy lifestyle.
• Avoid gaining too much weight during your pregnancy.
• If your baby is breech (positioned in some way other than head-down), talk with your healthcare team about ways they could try to turn the baby around from the outside.
• Wait for labor to start on its own (don’t try to get your labor started early).
• Wait to go to the hospital until you have strong and frequent contractions.
• Have good pain control when you are in labor.
• If you have been laboring for a long time and are exhausted, set an end point for yourself and tell your support people and healthcare team. When you reach the endpoint, you can decide with their help whether you want to try laboring longer or switch to a C-section.
• If it is not an emergency, and a C-section is suggested to you, do not be afraid to ask any questions you have.
• Try to stay relaxed and patient.

A Final Note

Planning a VBAC does not guarantee that you will avoid another C-section. But if you do need to have another C-section, our expert team will take care of you and your baby.

Download the BMC OB/GYN Guide to Giving Birth after a Cesarean (PDF)