Vaginal Birth After Cesarean (VBAC) Delivery

As you begin to discuss the delivery of your baby, you will want to discuss your options with your obstetrician or midwife.

• You can choose to attempt a VBAC.
• You can elect to have a scheduled cesarean delivery.

A VBAC delivery should be done in a hospital, such as Brigham and Women’s, where the staff is well-trained and experienced with this type of delivery.

There are many factors to think about. You will want to discuss this with your obstetrician or midwife well in advance of the delivery so that you have time to make the right decision for both you and your baby.

• Faster recovery: Your recovery will be faster with a VBAC delivery. This is an important consideration for women who already have children to care for at home.
• Lower complications: A vaginal delivery is associated with lower complications for you, including a lower risk of infection and blood loss.
• Future pregnancies: If you think you might want to have more children, you should know that the risk of problems increases with each additional cesarean. You should avoid multiple cesarean deliveries when possible.

• Shorter recovery
• Lower risk of infection for you and the baby
• Less blood loss
• May avoid problems associated with multiple cesarean deliveries (if you are planning on having more children)

• Prior uterine rupture: If you had a uterine rupture with a prior delivery, you are not a candidate for a VBAC.
• High risk pregnancies: If you have a problem with your pregnancy or a condition that makes a vaginal delivery risky, you are not likely to be a candidate for a VBAC.

• A possible rupture: A rupture of the cesarean scar on the abdomen or the uterus itself is rare. If a rupture does occur, most often there are no significant complications for you or your baby. Very rarely, however, a rupture can result in serious harm to both you and your baby. Your obstetrician will inform you if you are at a high risk for a rupture. If you are at risk, it is not recommended that you have a VBAC delivery.

You Are a Good Candidate for a VBAC

• Prior vaginal delivery: If you have had a prior vaginal delivery.
• Spontaneous labor: If you go into labor without the need to induce the labor (through drugs or other means).
• Non-recurring condition: If your prior cesarean delivery was due to a condition that is not likely to recur, such as a breech birth.

You Are Still a Candidate for a VBAC

• Induced labor: Induction of labor does not necessarily mean that you cannot have a VBAC. However, if your labor has to be induced by drugs or other means, this can be associated with a slightly increased risk of rupture and a slightly lower success rate. There are certain medications to induce labor that cannot be used for women attempting a VBAC. But many women, even with induced labors, go on to have a safe and successful vaginal delivery.
• Recurring condition: If your prior cesarean delivery was done for a condition that is likely to recur, such as a slow or stopped labor, you are more likely to end up with a cesarean delivery during an attempted VBAC. However, a VBAC is not prohibited and certainly may still be successful.
• More than one cesarean: A prior low transverse incision – an incision made horizontally across the lower end of the uterus – has the least chance of rupture with a risk of less than one percent. Even if you have had two deliveries with a low transverse incision, you can still consider a VBAC.

You are NOT a Candidate for a VBAC

• Vertical uterine incision: The type of incision in the uterine wall that you had for your prior cesarean is one consideration when considering your risk of rupture. There are three types of incisions made for cesarean deliveries: low transverse, low vertical and high vertical.
  • If you had a high vertical incision or a “classical cesarean” for a previous cesarean delivery, you will most likely NOT be a candidate for a VBAC.
  • You cannot tell which type of uterine incision that you had by looking at the scar on your abdomen. Your medical record from your prior delivery should include this information.
  • If you are not able to obtain the medical record of your prior delivery, you should discuss the VBAC option with your obstetrician to understand the risks for you and your baby.
• Contraindications for a vaginal delivery: You have a contraindication to a vaginal delivery, such as a breech baby in this pregnancy, or a placenta that is over your cervix.
• Other factors: Your obstetrician or midwife will discuss the following factors with you as you determine your chance of a successful VBAC:
  • Your age
  • Your body mass index
  • Your baby’s expected birth weight, especially a high weight
  • Your pregnancy is beyond 40 weeks of gestation
  • You have preeclampsia
  • There has only been a short time between your pregnancies

A birth can never be totally planned. So it is important to be prepared to reconsider your delivery plan if circumstances change during labor and delivery.

• Body Mass Index (BMI): A measure of a person’s weight in relation to height
• Breech Presentation: When the baby’s buttocks or feet (instead of the head) are delivered first
• Cesarean Delivery: Delivery of a baby through an incision made in the mother’s abdomen and uterus
• Gestation: The period between the conception and the birth of the child
• Preeclampsia: A complex disorder where pregnant woman will have high blood pressure and a high protein count in their urine after 20 weeks pregnant
• Rupture: The tearing apart, bursting, or breaking of tissue
• Uterine Rupture: A tear in the wall of the uterus. The tear will usually occur at the site of a previous cesarean delivery incision