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What is vaginal birth after cesarean (VBAC)?

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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 calculatorExternal Web Site Policy. 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.

  1. 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 Web Site Policy (PDF – 333 KB) [top]
  2. American College of Obstetricians and Gynecologists. (2010). Practice bulletin: Vaginal birth after previous cesarean delivery. Retrieved December 16, 2013, from Web Site Policy [top]
  3. 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]
  4. American Academy of Family Physicians. (n.d.). Trial of labor after cesarean (TOLAC): A shared physician-patient planning tool. Retrieved August 8, 2012, from [top]
  5. 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 Web Site Policy (PDF - 525 KB) [top]

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