Medical Professionals - Vaginal Birth After Cesarean (VBAC) Delivery

Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans, according to guidelines by The American College of Obstetricians and Gynecologists.

Of the women who elect to have a VBAC, between 60-80 % are successful. In keeping with past recommendations, most women with one previous cesarean delivery with a low-transverse incision are candidates for and should be counseled about VBAC and offered a Trial of Labor After Cesarean (TOLAC). In addition the College guidelines now clearly say that women with two previous low-transverse cesarean incisions, women carrying twins, and women with an unknown type of uterine scar are also considered appropriate candidates for a VBAC.

Because every woman and every birth is unique, you will want to counsel your patient about the benefits and risks well in advance of the expected delivery date to make the right decision for both mother and baby.

Benefits

• Decreased risk factors: A VBAC is associated with decreased maternal morbidity and a decreased risk of complications for future pregnancies.
• No abdominal surgery, less blood loss and faster recovery: The patient’s recovery will be much faster with a VBAC delivery.
• Future pregnancies: If the patient expresses interest in having more children, she should be informed that the risk of problems increases with each additional cesarean. Therefore, you will want to counsel her to avoid multiple cesarean deliveries when possible.

Risks

• A possible rupture: A rupture of the prior cesarean scar on the abdomen or the uterus itself is rare (between 0.5-0.9% 1) but it is very serious and can harm both mother and baby. Discuss with your patient her specific risks for a rupture.
• High risk pregnancies: If your patient has a high risk pregnancy or a condition that makes a vaginal delivery risky, she is not likely to be a candidate for a VBAC.

General Guidelines

Below is information on an easy-to-use calculator to determine if your patient is a candidate for a VBAC. You may also review this quick reference table.

VBAC Calculator on Labor and Delivery Scheduling Tool

In order to determine if your patient is an appropriate candidate for a VBAC, there is an easy-to-use calculator available when a repeat cesarean section is scheduled electronically in the Labor and Delivery application. You will be required to fill out the calculator when booking a repeat cesarean section.

This calculator is based on a prior validated study. There are other factors you may also consider.