Who Is a Good Candidate for a VBAC?

Every pregnancy comes with a slew of choices — baby names, nursery decor, and preferences regarding labor and delivery are aplenty. But what if this is your second or third pregnancy, and you’ve already had a cesarean section? Contrary to popular belief, that doesn’t necessarily mean that you must have a C-section — which accounts for nearly one-third of all deliveries — the next time around. Many women opt to try vaginal birth after a cesarean (VBAC), and the choice is a very personal one. If thinking about having a VBAC, here are a few important factors to consider.

Why Consider VBAC?

Studies have shown a 60 to 80 percent success rate for those who do attempt VBAC. When compared with having another cesarean, a vaginal delivery doesn’t involve the risk or complications of major abdominal surgery such as infection or blood loss, results in a shorter hospital stay, and leads to a swifter recovery and return to the usual daily activities. VBAC may also be appealing to those who have never experienced vaginal childbirth.

Also, for those who wish to have a larger family, VBAC can aid in reducing the risk of complications that can arise from multiple C-sections. Depending on the circumstances surrounding your previous C-section, VBAC might be an option for you.

What Are the Risks of VBAC?

When considering VBAC, you and your doctor should thoroughly go over your medical history, especially surrounding previous pregnancies. The biggest risk for women who undergo vaginal delivery after a cesarean is a uterine rupture, which is when a tear in the wall of the uterus occurs, often at the site of a previous C-section incision. Although rare — happening in less than 1 percent of women who attempt a trial of labor after cesarean — uterine rupture can be life-threatening for Mama and baby. If it does occur, an emergency C-section will be needed, potentially resulting in a blood transfusion and/or the surgical removal of the uterus (hysterectomy).

Many studies show that for women who have had one past C-section with a low transverse (horizontal) incision, the risk of uterine rupture is quite low: less than 1 percent. But a low vertical or high vertical incision carries a great risk of uterine rupture.

How to Tell If You’re a Good Candidate

There are a number of criteria that can help determine whether you’re more likely to have a successful VBAC. These include:

• Receiving a low traverse incision during a previous cesarean
• No history of uterine rupture
• Few additional uterine surgeries such as fibroid removal
• Having access to a doctor and staff on-site who can monitor labor and perform an emergency C-section, if needed

The following risk factors create conditions that could pose a threat to the health of the mother or baby and may not make someone an ideal candidate for VBAC:

• Receiving a low vertical or high vertical incision during a previous cesarean
• Being overweight
• Going beyond 40 weeks of gestation
• Requiring induction of labor
• Being of advanced maternal age
• Having shorter periods between pregnancies (18 months or less)
• Having a baby with a high estimated birth weight