Risks and Benefits of Vaginal Birth After Cesarean (VBAC)

If you delivered your last baby via cesarean section (C-section), your next delivery is going to take some forethought and professional advice.

Dr. Hughan Frederick and our expert team at Nile Women’s Health Care in Roswell and Suwanee, Georgia, specialize in guiding women through this decision process. Understanding the potential benefits and risks of vaginal birth after cesarean (VBAC) can empower you to make an informed choice that aligns with your health and birth preferences. Here’s what you should know.

VBAC 101

Vaginal birth after cesarean refers to delivering a baby vaginally after previously having a cesarean delivery. It offers you the opportunity to experience natural childbirth while avoiding the need for repeat surgery. 

However, the decision to attempt VBAC — also known as a trial of labor after cesarean (TOLAC) — is highly individualized and influenced by your medical history, the type of C-section incision, and your pregnancy’s overall risk level.

Benefits of VBAC

Many women choose VBAC for its potential advantages over a repeat cesarean delivery. Here are some of the top reasons VBAC is considered a favorable option:

Faster recovery

VBAC generally has a shorter recovery time. Recovering from vaginal delivery typically takes less time than healing from major abdominal surgery. With VBAC, most women can leave the hospital more quickly and return to their regular activities sooner.

Lower risk of surgical complications

VBAC avoids the need for abdominal surgery, reducing the risks associated with cesarean sections, such as:

• Excessive blood loss
• Infection
• Injury to surrounding organs like the bladder or bowel
• Risks associated with anesthesia

Although these risks exist, most women undergo C-sections without problems.

Potentially safer for future pregnancies

If you’re planning to have more children, avoiding multiple cesarean deliveries can reduce the risk of certain complications, including:

• Placental abnormalities, such as placenta accreta or previa
• Increased scarring in the uterus
• Risk of bowel or bladder adhesions in future surgeries

Again, severe complications are rare, but talk to our team about your family planning so we can guide you toward the best decision for your body.

Birth experience and benefits for the baby

Some women want to experience vaginal childbirth firsthand, and VBAC allows for a more active role in the labor process. Vaginal delivery also provides certain health benefits for the baby.

For example, vaginal birth helps clear amniotic fluid from the baby’s lungs during delivery, which can assist with breathing after birth. It also exposes the baby to beneficial bacteria in the birth canal, which may boost their immune system.

Risks of VBAC

While VBAC has many advantages, it’s not without risks, such as:

Uterine rupture

Uterine rupture is the most concerning potential complication of VBAC. This rare but serious event occurs when the cesarean scar on the uterus tears during labor. Uterine rupture can put both you and your baby at risk and often requires emergency intervention, such as an urgent C-section or, in some cases, a hysterectomy.

Uterine rupture occurs in less than 1% of women with a low transverse (horizontal) cesarean scar. However, the risk increases with other types of uterine scars, such as vertical or classical incisions.

Increased chance of emergency C-section

While 60%-80% of women who attempt VBAC succeed, some still require a repeat cesarean due to complications such as stalled labor or fetal distress. Emergency cesareans, compared to planned ones, are slightly riskier due to the situation’s urgency.

Other VBAC risks

A vaginal birth is the most natural way to deliver your baby, but that doesn’t mean it’s riskless. Every delivery is unique, and a vaginal delivery can be unpredictable. However, a VBAC could increase your risk of bleeding during delivery and infection.

In some cases, maternal exhaustion from prolonged labor occurs, especially if it transitions into an emergency cesarean.

Repeat C-section vs VBAC: Which is right for you?

Not every woman is a good candidate for VBAC. Here’s an at-a-glance view of the pros and cons.

Factors that may improve your likelihood of a successful VBAC include:

• Having a low transverse incision from the previous cesarean
• A history of at least one previous vaginal birth
• A current pregnancy considered low-risk
• Going into labor spontaneously before your due date

Conversely, certain conditions may make VBAC unsafe or less likely to succeed, such as:

• A vertical or classical uterine scar
• A history of uterine rupture
• Multiple previous cesareans (two or more)
• High-risk pregnancies involving complications such as preeclampsia, a large baby, or a placenta positioned abnormally

If you’d like to learn more about VBAC or explore your birth options, call either office of Nile Women’s Health Care. We can help you make an informed and confident decision about your delivery plan.