Vaginal delivery after C-section? Who are the best candidates?

Dreaming of birthing your baby outside of the operating room? Many women who have had a cesarean section and now want to give birth through a vaginal delivery have the option of doing just that. Vaginal birth after a C-section (cesarean), or VBAC, has many benefits, including a faster recovery after delivery, lower rate of complications, and less risk during future pregnancies.

Between 60 and 80 percent of women who attempt VBAC are successful, while the remaining 20 to 40 percent end up back in the operating room for a cesarean delivery.

The best candidates for vaginal delivery after C-section are women who have had:

• A prior vaginal delivery
• Have spontaneous (non-induced) labor
• Not had prior conditions that could possibly recur, such as labor that fails to progress or the delivery of a large infant

If you’ve previously been induced, it does not mean that VBAC is impossible. But it’s good to note that prior labor induction is associated with a slightly lower success rate. Also, some medications used to induce labor cannot be used during VBAC.

VBAC is not an option for women who have had a vertical incision with a prior cesarean delivery or have had prior uterine surgery, such as a myomectomy. VBAC also carries a small risk of rupture, where there is separation along the scar from a prior cesarean. In these cases, a woman’s health care team will perform an emergency cesarean delivery.

It is very important when considering VBAC to deliver your baby in a hospital with vast experience in emergency cesarean deliveries. These are typically hospitals that perform many deliveries each year and have specialists in high-risk pregnancy and delivery and readily available anesthesia.

It’s important to speak with your physician for more information about this option and to learn if you are a good candidate for attempting a vaginal delivery after you’ve undergone a C-section. 

We’ve partnered with Boston’s Brigham and Women’s Hospital, a major teaching hospital of Harvard Medical School, to answer your most pressing questions about your health during pregnancy and beyond. Have a question you’d like our team of doctors to answer? Leave it in the comments below and the BWH staff may answer it in an upcoming article. 

About our doctors: Louise E. Wilkins-Haug, MD, PhD is the Division Director of Maternal Fetal Medicine and Reproductive Genetics at Brigham and Women’s Hospital. Sarah Elizabeth Little, MD, MPH, is a Maternal-Fetal Medicine specialist in the Department of Obstetrics and Gynecology at Brigham and Women’s Hospital.