What Is a VBAC?

Woman in delivery room

Getty Images / Kemal Yildirim

If you're pregnant and previously had a cesarean section (C-section), you may be wondering whether you'll be able to deliver your next baby vaginally.

It was once assumed that pregnant individuals who've had a C-section would automatically deliver their subsequent children in the same fashion. However, research has shown vaginal birth after cesarean (VBAC) is a safe option for many women.

Here, we are going to dive in and share more about VBACs, including the benefits and risks. We will also touch on what makes someone a candidate for a successful vaginal birth after a cesarean.

Why Choose a VBAC?

Many people have had successful C-sections and are content to repeat the process for their next delivery. This is especially true for pregnant people with certain medical conditions or fetal risks. The C-section rate has increased to more than 31% in the United States, meaning nearly 1 in 3 deliveries is a cesarean.

If you've had a C-section in the past, your medical professional will speak to you early in your pregnancy regarding your plans for delivery. This would be an appropriate time to discuss a trial of labor after cesarean — or TOLAC. A TOLAC refers to the intention to attempt a vaginal delivery after a C-section.

"A trial of labor after cesarean has the highest chance of working if the mother has had a prior vaginal delivery before having a C-section and when a prior C-section was uncomplicated with an incision in the lower uterus," said Eric Anderson, MD, a pediatrician at Atrius Health in Burlington, Massachusetts.

Those who've had a C-section know the process is considered major surgery, and the recovery period can be more strenuous than with a vaginal birth.

Advantages of Having a VBAC Include:

  • Avoiding abdominal surgery.
  • Lower risk of infection, such as placenta accreta and placenta previa.
  • Shorter recovery period.
  • Eliminating the risk of surgical complications, including bowel or bladder injuries.

Who Is a Good Candidate?

The National Institute of Child Health and Human Development has conducted research indicating approximately 75% of VBAC attempts are successful among appropriate candidates.

Criteria For a VBAC

Your provider may agree you are a candidate for a VBAC if you meet the following criteria:

  • You have no existing conditions that would normally require a cesarean, such as placenta previa.
  • The reason for your previous C-section was situational. For example, if your baby was in the breech position.
  • You've had one previous C-section with a low transverse uterine incision. However, some hospitals and birth centers allow VBACs if you have had multiple cesareans with low transverse uterine incisions.
  • You are delivering at a facility with the capability of performing an emergency C-section, if necessary.

Attempting a VBAC during a home birth is not recommended given the inability to perform a C-section if needed and lack of access to on-site blood transfusions should the need arise.

Why You May Be Denied a VBAC

Depending on your situation, a VBAC may not be advisable. A repeat C-section may be a safer choice.

Risks for Getting a VBAC

  • You've had uterine surgery in the past.
  • You have a high vertical uterine incision.
  • You have experienced a uterine rupture.
  • Your baby is in an undesirable position for a vaginal birth, or you have other pregnancy complications.

In some cases, your doctor or midwife may deny you a VBAC for other reasons. If your healthcare provider refuses to offer a VBAC, it's important to understand why they feel it is medically not a wise idea. Some providers do not support VBACS or may have an insurance policy indicating they should not perform them.

Additionally, some hospitals have a no-VBAC policy. If you're denied a VBAC for non-medical reasons, you must decide whether you would like to stick with your current provider and hospital or switch to a VBAC-friendly practice.

What Are the Risks of a VBAC?

Risks associated with VBACs are rare but serious. One concern is that the preexisting cesarean scar could rupture or break open, placing the baby in danger. In this case, your provider would require an emergency C-section.

Cesarean deliveries also leave you with a scar not only on your skin—but also on your uterus. Certain uterine scars carry a higher risk of rupturing during a VBAC, so it's important to know the type of incision you received. Possibilities include:

  • High vertical, or “classical.” This is an up-and-down incision in the upper part of the uterus, which you may have if you had a preterm C-section delivery. The high vertical scar carries the highest risk of rupture.
  • Low transverse means the incision was made vertically across the low, thin area of the uterus. Luckily, this is the most common type of incision and has the lowest rupture risk.
  • Low vertical, a vertical cut in the lower, thinner part of the uterus. It has a higher risk of rupture than a low transverse incision but lower than a high vertical.

What's Your Incision Type?

The scar on your skin alone will not tell you what kind of incision was made in the uterus. To determine this, locate your medical records for information about your previous delivery or deliveries.

Preparing for a VBAC

The first step in preparing for a VBAC is to speak to your provider about your medical history and candidacy. In reviewing your health records, your doctor or midwife should assist you in determining the likelihood of a successful VBAC.

Be sure to research your hospital or birthing facility to ensure it is equipped to handle any potential complications that may arise during your labor. You'll want to make certain an emergency C-section is an option if your VBAC doesn't go according to plan.

Otherwise, if you're a good candidate and have a low-risk pregnancy, your preparation will be no different from getting ready for any other vaginal delivery. You will go into labor on your own or be induced, though your healthcare team will likely monitor you more closely during the process.

A Word From Verywell

Most pregnant people who are candidates for a VBAC successfully deliver their babies vaginally without complications. If you're interested in having a VBAC, speak candidly to your healthcare provider about your medical history to determine whether or not this delivery method is right for you.

Typically, if you're in good health and there is no fetal risk, your provider will give you the green light to move forward with attempting a VBAC. However, some doctors and hospitals are not VBAC-friendly, which will leave you with a decision to make about your practice should you be denied the opportunity.

Most people who meet the criteria for attempting a TOLAC will be successful. Speak to your provider about your options to see if a VBAC is possible where you wish to deliver.

2 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. Births - methods of delivery.

  2. Landon MB, Grobman WA. What we have learned about trial of labor after cesarean delivery from the maternal-fetal medicine units cesarean registrySemin Perinatol. 2016;40(5):281-286. doi:10.1053/j.semperi.2016.03.003

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By Renee Plant
Renee Plant is a health and wellness freelance writer with a passion for delivering well-researched, factual content to readers.