Risks and Benefits of Vaginal Birth After Cesarean (VBAC)

In the United States, Cesarean deliveries account for about 32% of all births, making it one of the most common surgical procedures. Each year, roughly 1 million babies are delivered via C-section in the US.

If you've previously had a C-section, you might have heard concerns about the possibility of the uterine scar rupturing during subsequent labor, leading to the belief that C-sections are the safest choice for future deliveries.

Contrary to this belief, vaginal birth after Cesarean (VBAC) is a safe and viable option for many women.

Here, the experts at North Atlanta Ob/Gyn in Atlanta, Georgia, discuss the potential risks of VBAC as well as its benefits and the factors that can help determine whether it's a suitable option for you.

Understanding VBAC

Historically, women who had undergone a C-section were often told that any future deliveries would also need to be C-sections. The saying "Once a Cesarean, always a Cesarean" reflected concerns that laboring and delivering vaginally after a C-section could lead to uterine rupture.

Fortunately, this serious complication is rare, occurring in less than 1% of women who attempt a trial of labor after Cesarean (TOLAC). Moreover, VBAC is successful in approximately 75% of women after one C-section and about 50% of those who attempt it after two C-sections.

Advantages of VBAC

If your previous C-section was unplanned—perhaps due to complications like fetal distress or prolonged labor—or if you did not enjoy the recovery process, VBAC offers several benefits over another C-section, including:

• Quicker recovery: A successful VBAC avoids the need for surgery, resulting in a shorter hospital stay and a faster return to normal activities. It also eliminates the risks of surgical complications like heavy bleeding, infection, and damage to organs like the bladder or bowel.
• Reduced risks in future pregnancies: Choosing VBAC can help prevent the complications associated with multiple C-sections, such as increased risk of uterine rupture in subsequent pregnancies and issues with the placenta, including placenta previa or placenta accreta, which can lead to severe bleeding and other complications.
• Health benefits for the baby: Vaginal delivery helps clear amniotic fluid from the baby's lungs, aiding their breathing right after birth, and exposes them to beneficial microbes that can boost their immune system.

Potential VBAC Risks

Although a successful VBAC generally carries fewer risks than a planned repeat C-section, an unsuccessful attempt can lead to more severe complications.

• Uterine rupture: The scar left by a previous C-section can potentially rupture under the pressure of labor, a serious and life-threatening condition for both mother and baby.
• Possible hysterectomy: If a uterine rupture occurs, an emergency C-section is performed to deliver the baby, often followed by procedures to stop bleeding, which may include a hysterectomy, thereby ending the ability to conceive.
• Emergency C-section: Even without uterine rupture, an attempted VBAC may end in an emergency C-section, which typically carries more risks than a scheduled one.

Is VBAC Right for You?

The team at North Atlanta Ob/Gyn considers several factors when assessing whether VBAC is a safe and likely option for you:

• Having no more than two previous C-sections
• Having a low transverse incision, which is less likely to rupture
• No history of other uterine surgeries
• A previous vaginal birth or successful VBAC
• Absence of conditions that make vaginal delivery risky

VBAC may not be recommended if you have:

• Experienced more than two C-sections
• A vertical incision, which has a higher risk of rupture
• Needed a C-section due to non-progressing labor
• Had your last baby within the past 18 months
• A history of failed VBAC or uterine rupture

Additionally, VBAC success rates decrease if labor needs to be induced past the due date if the mother is over 35, overweight, or expecting multiples.

Are you considering a VBAC? The team at North Atlanta Ob/Gyn can help you assess your individual risk factors and options. We have three convenient locations in Atlanta, Marietta, and Alpharetta, Georgia.

 Call us today, or schedule an appointment online to discuss your situation.