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Many women who have had one cesarean can safely try for a vaginal birth in their next pregnancy. This is called VBAC, short for vaginal birth after cesarean. Whether it is right for you depends on your health, your earlier surgery and your hospital's facilities.
It is a decision to make with your doctor, with clear information about benefits and risks. This guide explains both sides in plain language.
What are VBAC and TOLAC?
TOLAC means a trial of labour after cesarean, when you go into labour planning for a vaginal birth. If it succeeds, it is a VBAC. If it does not, the birth ends in a cesarean. The other option is a planned repeat cesarean, usually arranged around or just before your due date.
Who may be a candidate for VBAC?
Cleveland Clinic says your chances of a successful VBAC are high if your earlier cesarean used a low transverse (side-to-side) cut on the uterus, you have no other uterine scars or abnormalities, you have had a vaginal birth before, and you have never had a uterine rupture.
Hospital guidance from the UK (Cambridge University Hospitals and Leeds Teaching Hospitals) says VBAC is generally not advised if you have:
- Three or more previous cesareans
- A previous uterine rupture
- A classical (high, vertical) cut on the uterus
- Another pregnancy problem that makes a cesarean the safer choice
Guidelines vary between countries and hospitals, especially for women with two earlier cesareans. The UK hospitals above say a conversation with a senior obstetrician is advised in that case. Always ask your own doctor.
What are the chances of success?
Figures differ by source. Cambridge University Hospitals says about 75 in 100 women with a straightforward pregnancy and spontaneous labour give birth vaginally after one cesarean, while Leeds Teaching Hospitals quotes about 90 in 100 for the same situation. Both agree the chance is higher if you have given birth vaginally before, which Cambridge puts at about 90 in 100. Because the numbers differ, treat them as a rough guide and ask your doctor about your own odds.
Both hospitals list things that lower the chance of success:
- Never having had a vaginal birth
- Labour that needs to be induced
- A previous cesarean for slow progress in labour
- A body mass index (BMI) over 30 at booking
- Less than 12 months since the last cesarean (Cambridge)
Benefits of a successful VBAC
- A vaginal birth, which can be assisted if needed
- Shorter recovery and hospital stay, and less wound pain
- No major abdominal surgery and its risks, such as infection, clots and bleeding
- A better chance of a vaginal birth in future pregnancies
- Less scarring inside the abdomen, which matters if you may have more children
Risks of trying for a VBAC
The main risk is that the scar on the womb may open during labour, called uterine rupture. The two UK hospitals above put this at about 0.2 to 0.5 percent, or 2 to 8 in 1,000 labours. Cleveland Clinic says rupture is rare but serious, and that it can reduce the baby's oxygen supply and cause heavy bleeding for the mother. The risk is higher with induction, and Cleveland Clinic says it rises after more than one previous cesarean.
Other points to know:
- About 1 in 4 VBAC labours end in an unplanned cesarean, compared with about 1 in 5 first labours (Cambridge and Leeds).
- An unplanned cesarean after labour carries a bit more risk of blood transfusion or infection than a planned repeat cesarean, about 1 percent higher according to both hospitals.
- The chance of serious harm to the baby is small but slightly higher with a VBAC attempt than with a planned repeat cesarean.
When to be cautious: sudden severe tummy pain, a change in contractions, vaginal bleeding, a racing heart, dizziness or reduced baby movements during labour can signal a problem with the scar. Tell your care team immediately. Do not stay at home to see if it passes.
Risks of a planned repeat cesarean
A repeat cesarean is also a valid choice and is not a failure. It has almost no risk of scar rupture, and you know the date. But it is major surgery, and Cambridge notes possible longer or harder surgery from scar tissue, a longer recovery, and rising risks with each further cesarean, such as problems with the placenta in future pregnancies. Breathing problems in the baby are also more likely with planned surgery before 39 weeks.
Planning a VBAC safely
- Share your records. Bring your earlier operation notes, including why the cesarean was done and the type of cut.
- Discuss early. Talk to your doctor during pregnancy, not in labour. Decisions can be revisited as your pregnancy progresses.
- Choose a hospital that can act quickly. Both UK hospitals recommend giving birth in hospital so an emergency cesarean is possible. Home birth after a cesarean has no safety evidence behind it.
- Expect close monitoring. Continuous monitoring of the baby's heartbeat is usually advised once labour is established, and a drip may be placed in case medicines are needed.
- Know the options if labour does not start. Choices include waiting, induction or a planned cesarean. Induction can lower the chance of success and raise the chance of rupture, so discuss it carefully.
Tip: ask your doctor to write down your plan and the reasons for it, so it is clear to the team on duty when you come in.
When to see a doctor
Book a visit as soon as you know you are pregnant if you have had a cesarean. Contact your hospital promptly if you have:
- Regular contractions, or your waters break
- Vaginal bleeding
- Constant or sudden severe abdominal pain
- Pain or opening of your old scar
- Reduced baby movements
Read more about your birth choices in normal delivery vs cesarean, how healing works in C-section recovery tips, and our normal and C-section deliveries service. Previous cesarean pregnancies are often followed in high-risk pregnancy care, where closer planning is possible.
Talk to a doctor
If you have questions about your own situation, you are welcome to book an appointment or call us on +91 944 103 0587. Chaitanya Hospital in Kadapa offers 24/7 delivery and emergency care, and teleconsultation is available. This article is for general awareness and is not a substitute for a doctor's advice.
References
This article was written in our own words from the following public health sources.
Educational content
Please note. This article is for general awareness and is not a substitute for a doctor’s advice, diagnosis or treatment. If you are worried about your health, or in an emergency, call +91 944 103 0587 or visit the hospital.
