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Patient education: Vaginal birth after a cesarean (The Basics)

Patient education: Vaginal birth after a cesarean (The Basics)

What is a vaginal birth after a cesarean? — This is when a person gives birth to a baby through the vagina (figure 1) after they had a baby by c-section in the past. A c-section, also called a "cesarean delivery" or "cesarean birth," is surgery to get a baby out of the uterus (figure 2). A vaginal birth after a cesarean is called a "VBAC" for short.

Years ago, doctors thought that if you had 1 c-section, you would have to have any future babies by c-section too. That's because the uterus is cut open during a c-section. Even though the cut is stitched up and heals, doctors worried that the original cut could open up during labor. Doctors now know that this rarely happens. Many people can safely have a vaginal birth after a c-section.

If you have had a c-section in the past, you will usually have a choice about how you will give birth to your other babies. You can either:

Plan to go through labor and try to have a vaginal birth – Doctors call this a trial of labor after cesarean, called "TOLAC" for short. A trial of labor might work and end with a VBAC. But sometimes it doesn't work, and you will need another c-section to have your baby.

Plan to have another c-section before labor starts

What are the benefits of a VBAC? — The benefits of a VBAC include:

A shorter stay in the hospital after giving birth

Less pain after the birth and a shorter recovery time (usually)

Fewer problems after the birth – People who have a c-section have a higher chance of getting a fever, infection, blood clot in the legs, or needing blood.

What problems might happen with a trial of labor? — Different problems can happen with a trial of labor. But the problem doctors and midwives worry about most is the uterus tearing. Doctors call this a "uterine rupture." This is an emergency, and can cause harm to you and your baby. If it happens, a c-section needs to be done right away to get the baby out and fix the tear.

Plus, sometimes a trial of labor doesn't work. The labor might not progress normally and you might need to have a c-section anyway. This can be upsetting and stressful.

What if I want to try and have a VBAC? — If you want to try and have a VBAC, let your doctor or midwife know. Based on your individual situation, they will help you decide whether a trial of labor is a good choice for you.

In general, a trial of labor has the highest chance of working when:

You had a vaginal birth in the past (in addition to having a c-section)

The first c-section was done because your baby was in a breech position. A breech position is when a baby's legs or buttocks (and not head) are closest to the vagina (figure 3).

In some cases, a trial of labor is not recommended. This happens when:

The uterus was not cut open in the usual way during the previous c-section

A uterine rupture (tear) happened in a past pregnancy

A vaginal birth isn't safe for you or your baby

Plus, your doctor or midwife will only let you have a trial of labor in a hospital or center where a c-section could be done right away if needed.

More on this topic

Patient education: C-section (cesarean birth) (The Basics)
Patient education: Labor and delivery (childbirth) (The Basics)
Patient education: How to tell when labor starts (The Basics)

Patient education: C-section (cesarean delivery) (Beyond the Basics)

This topic retrieved from UpToDate on: Jan 02, 2023.
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