VBAC 101: Intro to Vaginal Birth After Cesarean (VBAC)

July 30th is VBAC Awareness Day, and what better way to kick it off than to go back to basics. Consider this the VBAC primer that introduces you to Vaginal Birth After Cesarean (VBAC). It's important to know that VBAC isn't risk-free, but there is a 75% chance you can experience a vaginal birth after a prior C-section.

Let's start at the beginning, what is VBAC?

If you have had a cesarean delivery before, you may be able to deliver your next baby vaginally. This is called vaginal birth after cesarean, or VBAC.

There are certain risk factors that you will discuss with your birth team, to help you decide what you’re comfortable with. If you’re ‘low risk,’ like the majority of pregnancies, then planning for a VBAC may be an option.

If you and your birth team agree to try a VBAC, you will have what is called a "trial of labor after cesarean," or TOLAC. This means that you plan to go into labor with the intention of birthing vaginally. For the record, I don’t love the words “trial of labor,” but we’ll use it for familiarity in this section.

As with any labor, there is still a possibility that a Cesarean may be necessary. About 25 out of 100 women who have a trial of labor need to have a Cesarean. This means about 75 out of 100 women who have a TOLAC birth vaginally.

What are the barriers to VBAC?

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 cesarean.
A cesarean might be recommended if you have certain placental problems.
Your baby is in an abnormal position. Sadly, not all doctors are trained in vaginal breech birth.
You're carrying multiple babies. Again, some providers and hospitals are not supportive of VBAC with multiples.

If you're considering VBAC, your health care provider can help you review the risks and provide enough information for you to make the right decision for you and your family.

What to consider when planning your VBAC

There are a few things to consider before a VBAC. Knowing your health history and a few facts to discuss with your birth team can help you make an informed decision that is right for you and your baby.

What type of uterine incision was used for your previous C-section? If you had a low transverse or low vertical incision → good sign. If you've had a previous high vertical incision, note that there is an increased risk of uterine rupture with VBAC.
If you've had other uterine surgeries, such as for fibroid removal, VBAC isn't recommended because of the risk of uterine rupture.
Vaginal delivery at least once before or after your prior C-section increases your probability of having a VBAC.
Many health care providers won't offer VBAC if you've had more than two prior C-sections. Note that this doesn't mean you cannot do it. Open a conversation about the risks and benefits associated with VBAC, and consider seeking out the advice of a midwife.
When did you last give birth? The risk of uterine rupture is higher if you attempt VBAC less than 18 months after your previous delivery.

Vaginal birth after cesarean myths

There is an old myth out there that says ‘once a C-section, always a C-section.’ Such myths about VBAC often influence families, who decide to repeat a cesarean. The result is a 92% repeat cesarean rate, even though most subsequent pregnancies are capable of & can achieve a vaginal birth.

To help you make an informed choice about your birth, you need to know the myths and truths about vaginal birth after a cesarean.

"Once a cesarean, always a cesarean." NOT true. VBAC is a safe choice for most families who have had one cesarean and even some who have had two cesareans (called a VBA2C).
"During labor, you can't have an epidural because it will mask the pain of uterine rupture." About 25% of women who experience a uterine rupture report abdominal pain, so it is an unreliable symptom.
"There are no risks associated with cesareans other than surgery." Risks of cesarean-related complications increase with each subsequent cesarean. These complications include placental abnormalities such as placenta accreta, which leads to a hysterectomy that would prevent future pregnancies.

Recap: Your first steps in preparing for a vaginal birth after cesarean

Request your previous Cesarean records and initiate an open discussion with your provider about your specific situation. If the discussion isn’t matching with evidence on VBAC, you may consider getting a 2nd, or 3rd, opinion.
Wait at least 18 months in between delivering your babies.
Hire a doula to be the hands-on physical and emotional support you need to achieve your goal. Having constant hands-on support from a trained doula has been proven to increase your odds of a vaginal delivery.

Take a childbirth class specifically on vaginal birth after cesarean! Here is my VBAC Prep Birth Course for expectant couples considering Vaginal Birth After Cesarean (VBAC). We will cover everything from VBAC risks and perspectives to expectations during labor, what to expect during pushing and more to prepare you for delivery.