If you've delivered a baby by C-section and you're pregnant again, you might be able to choose between scheduling a repeat C-section or a vaginal birth after cesarean (VBAC).
For many women, attempting a trial of labor after cesarean (TOLAC) is possible. In 2013, the success rate for women in the U.S. who attempted a trial of labor after one previous cesarean was 70%.
VBAC isn't right for everyone, though. Certain factors, such as a high-risk uterine scar, can lower your likelihood of VBAC and make the option inappropriate. Some hospitals don't offer VBAC because they don't have the staff or resources to handle emergency C-sections. If you're considering VBAC, your health care provider can help you understand if you're a candidate and what's involved.
Common reasons for choosing a trial of labor after cesarean include:
You might be a candidate for VBAC if you are:
One of the greatest predictors of a successful VBAC is a prior vaginal delivery.
You're not a candidate for VBAC if you have any condition that would prevent vaginal delivery or you have had:
Many health care providers won't offer VBAC if you've had more than two prior C-sections or you have a body mass index of 50 or higher at the time of delivery and you've never had a vaginal delivery. VBAC also generally isn't an option if you are pregnant with triplets or higher order multiples.
Factors that decrease the likelihood of VBAC include:
While a successful VBAC is associated with fewer complications than an elective repeat C-section, a failed trial of labor after cesarean is associated with more complications, including, rarely, a uterine rupture. If a scar on your uterus from a previous cesarean tears open during a trial of labor, an emergency C-section is needed to prevent life-threatening complications for you and your baby. Treatment might involve surgical removal of the uterus (hysterectomy). If your uterus is removed, you won't be able to get pregnant again.
If you've previously had a C-section and you're pregnant, you might begin talking about VBAC at your first prenatal visit. Discuss your concerns and expectations with your health care provider. Make sure he or she has your complete medical history, including records of your previous C-section and any other uterine procedures. Your health care provider might use your medical history to calculate the likelihood that you'll have a successful VBAC.
Also, plan to deliver your baby at a facility that's equipped to handle an emergency C-section. Continue discussing the risks and benefits of VBAC throughout pregnancy, especially if certain risk factors arise.
If you choose VBAC, when you go into labor you'll follow the same process that's used for any vaginal delivery. Your health care provider will likely recommend continuous monitoring of your baby's heart rate and be prepared to do a repeat C-section if needed.