VBAC refers to successful vaginal delivery of a baby after a woman has delivered a baby by C-section in a previous pregnancy.
In the past, pregnant women who had a prior cesarean delivery would automatically have another C-section. But research shows that, for many women who had prior C-sections, attempting to give birth vaginally—called a trial of labor after cesarean delivery (TOLAC)1—should be considered.
When is VBAC appropriate?
VBAC may be a safe and appropriate choice for some women, including those2:
- Whose prior cesarean incision was across the uterus toward its base (called a low-transverse incision), the most common type of incision. Note that the incision on the uterus is different than the incision on the skin.
- With two previous low-transverse cesarean incisions
- Who are carrying twins
- With an unknown type of uterine incision
Benefits of VBAC include2:
- No abdominal surgery
- A lowered risk of hemorrhage and infection, compared with a C-section
- Faster recovery
- Possibly avoiding the risks of many cesareans, such as hysterectomy, bowel and bladder injury, infection, and abnormal placenta conditions
- Greater likelihood of being able to have more children in the future
NICHD research has shown that among appropriate candidates, about 75% of VBAC attempts are successful.3 A 2010 NIH Consensus Development Conference on Vaginal Birth After Cesarean evaluated current data on VBAC and issued a statement determining that it is a reasonable option for many women.
In addition, NICHD-supported researchers developed a way to calculate a woman's chances of a VBAC. Access the calculator. Please note that this calculator only determines the likelihood of VBAC; it does not guarantee success.
But it is still possible that a woman will have to have a cesarean after having a trial of labor. Most risks associated with TOLAC are similar to those associated with choosing a repeat cesarean. They include4,5:
- Uterine rupture
- Maternal hemorrhage and infection
- Blood clots
- Possible need for a hysterectomy
A woman considering VBAC should discuss the issue with her health care provider.
- American College of Obstetricians and Gynecologists. (2011). FAQs: Vaginal birth after cesarean delivery: Deciding on a trial of labor after cesarean delivery. Retrieved July 22, 2013, from http://www.acog.org/~/media/For%20Patients/faq070.pdf?dmc=1&ts=20130513T1537419082 (PDF – 333 KB) [top]
- American College of Obstetricians and Gynecologists. (2010). Practice bulletin: Vaginal birth after previous cesarean delivery. Retrieved December 16, 2013, from http://www.acog.org/Resources_And_Publications/Practice_Bulletins/Committee_on_Practice_Bulletins_Obstetrics/Vaginal_Birth_After_Previous_Cesarean_Delivery [top]
- Landon, M. B., Leindecker, S., Spong, C. Y., Hauth, J. C., Bloom, S., Varner, M. W., et al. (2005). The MFMU Cesarean Registry: Factors affecting the success and trial of labor following prior cesarean delivery. American Journal of Obstetrics and Gynecology, 193, 1016–1023. [top]
- American Academy of Family Physicians. (n.d.). Trial of labor after cesarean (TOLAC): A shared physician-patient planning tool. Retrieved August 8, 2012, from http://www.aafp.org/online/etc/medialib/aafp_org/documents/clinical/patient_ed/tolac-color.Par.0001.File.tmp/TOLAC-color.pdf [top]
- American Academy of Family Physicians. (2005). Trial of labor after cesarean (TOLAC), formerly trial of labor versus elective repeat cesarean section for the woman with a previous cesarean section. Retrieved November 18, 2014, from http://www.annfammed.org/content/suppl/2005/07/26/3.4.378.DC1/TOLAC_2005_Guideline.pdf (PDF - 525 KB) [top]