Vaginal Birth After Cesarean (VBAC)

If you’re pregnant after previously having a cesarean birth, you’re likely wondering whether a vaginal birth is possible or if you should schedule another cesarean delivery. At The Ohio State University Wexner Medical Center, our obstetrician-gynecologists (Ob/Gyns) are trained to manage vaginal births after cesarean (VBAC). We provide individualized counseling and safe, evidence-based support to help you determine if the benefits of a VBAC outweigh any risks.

Your pregnancy team, which could include a certified nurse-midwife or a Maternal Fetal Medicine specialist, will help you understand your options, evaluate your eligibility and make a birth plan prioritizing your safety and preferences.

What is a VBAC?

A VBAC is a vaginal delivery after a previous cesarean birth. It’s sometimes also called TOLAC (trial of labor after cesarean). This is when you and your provider determine it’s safe to plan and attempt a vaginal delivery for your pregnancy, with the understanding that a C-section may still become necessary.

In many healthy pregnancies, a VBAC can be an option for delivery, especially if the previous cesarean surgery was performed using a low transverse (horizontal) incision on the uterus. If you and your provider decide a VBAC is the best option for you, our team will monitor your labor closely and be able to quickly change course if necessary.

What are the benefits of VBAC?

A C-section is a major surgery that comes with risks and a longer recovery time. A VBAC can have significant advantages when it’s a safe option for you and your baby, and something you prefer. These benefits include:

• Shorter hospital stay and faster recovery
• Less postpartum pain
• Lower risk of infection, bleeding and complications
• Reduced risk of complications in future pregnancies
• A higher breastfeeding success rate

If you’re planning to have additional pregnancies, avoiding another cesarean birth can increase your chances of having safer pregnancies and deliveries in the future.

Who is a candidate for a VBAC?

If you’re considering a trial of labor after cesarean, your pregnancy care team will review your history, surgical records and current pregnancy to assess the likelihood of a successful VBAC. We encourage open discussion about your preferences and goals. Here are some factors that make a safe VBAC more likely:

• A prior vaginal birth, especially a prior VBAC
• Spontaneous onset of labor
• Healthy maternal weight
• The reason for a prior C-section doesn’t recur, such as breech presentation
• A healthy pregnancy without significant complications

How successful is a VBAC?

Nearly three in four people who try to deliver vaginally after a cesarean birth in the United States succeed. This mirrors our rate of success at the Ohio State Wexner Medical Center.

When may VBAC not be recommended?

Besides having a prior classical or vertical uterine incision, your provider may recommend scheduling a C-section if you have any of these:

• A prior uterine rupture
• Three or more prior cesarean births without a vaginal birth
• Placenta previa or placenta accreta spectrum (where the placenta covers the cervix or implants too deeply into the uterine wall)
• A pregnancy with multiples
• A breech fetal position

What are the risks of a VBAC?

VBAC is a safe option for many, but it does carry risks. If your labor doesn’t progress safely for any reason, your care team may recommend transitioning to a C-section. Besides a VBAC not being successful, other risks include:

• Blood loss
• Infection
• An emergency C-section, which can carry more risks than a scheduled, planned one
• Uterine rupture
• Baby escaping uterus, leading to neurological deficits or even death

Uterine rupture, where the previous scar on your uterus tears during labor, is a serious but rare complication. It requires immediate surgical delivery for your safety and your baby’s. It can also require a hysterectomy (the removal of the uterus). It’s more likely with a prior, high vertical incision, which is why doctors may refuse a VBAC in this case.

The risk of uterine rupture is also higher if there isn’t enough time between your C-section and your next baby’s conception. It’s best to wait 18 months between delivery and conception if you’ve had a prior cesarean section and are planning a vaginal delivery.

What to expect if you plan a VBAC

Going into a VBAC is similar to any other labor, including postpartum recovery. The main difference will be that your care team will monitor your baby more closely and be ready to perform a C-section immediately, if necessary. While each person’s labor and delivery will be personalized, here are some things you can expect:

Before a VBAC delivery

• A comprehensive review of your medical and surgical history
• Shared decision-making discussion with your primary Ob/Gyn specialist or midwife, and possibly one of our Maternal Fetal Medicine specialists
• Acknowledgment of a clear birth plan that includes contingency options

During a VBAC labor and delivery

• Continuous monitoring of your contractions and fetal heart rate
• Access to pain management options, such as an epidural
• Communication on progress

If a cesarean birth becomes necessary, your team will discuss any important changes with you, will act quickly if needed and will keep your preferences at the center of the decision-making process.

Why choose Ohio State for your VBAC?

If you’re considering VBAC, our team will help you understand your options and create a delivery plan that prioritizes your safety and your birth goals. And if you and your provider determine you’re a good candidate for a VBAC, delivering at our new Maternity Center means you’ll have every possible resource available for a safe labor and delivery. Here are some other reasons why people have their VBACS at Ohio State:

Shared decision-making

We take a team-based approach to delivery, which means you and your preferences remain at the center of every decision throughout labor and your baby’s birth.

Constant collaboration

Our team of high-risk obstetricians, midwives, generalists, anesthesiologists and nursing staff all collaborate to give you the best possible prenatal, delivery and postpartum experience. This includes:

• Continuous fetal monitoring
• A team of high-risk Maternal Fetal Medicine specialists
• Obstetric Emergency Department, open 24/7
• Level III neonatal intensive care unit
• The latest evidence-based safety protocols
• In-house anesthesiology team available at all times

Latest labor and delivery amenities

Our Maternity Center is located on floors 22 through 24 of the stunning new hospital tower. With private rooms, floor-to-ceiling windows and views all across campus, parents who are expecting multiples can give birth and recover in a comfortable, healing and luxurious space.

Research and innovation

As an academic medical center, our physicians and specialists do the research that creates the guidelines and protocols surrounding best practices in labor and delivery. You’ll receive care based on the most up-to-date scientific evidence and discoveries.