Vaginal Birth After Caesarean – VBAC

Many women can safely and successfully deliver their baby vaginally, even after having previously had a Caesarean section.  Vaginal birth after a C-section (VBAC) is a safe and viable option.

Vaginal birth has several benefits that include:

  • A faster recovery, making it easier to breastfeed, take care of other children, and return to your usual level of activity
  • Lower risk of infection
  • Shorter hospital stay
  • Avoiding another scar on your uterus and reducing the chance of problems with a later pregnancy
  • Less pain in the long term
  • Eliminates complications related to surgery

Please speak with your health care provider to learn more about the options you have for the birth of your baby.

Eight common questions about a VBAC

Can I still have a traditional delivery?

Caesarean section (C-section) can still safely give birth to a child through a normal vaginal delivery. Attempts at vaginal birth after Caesarean (VBAC) have a high success rate and have many benefits.

Whether it is right for you depends on several things, including why you had a C-section before and how many C-sections you’ve had. You and your doctor or midwife can talk about your risk for having problems during a trial of labour. In cases where a vaginal birth attempt is unsuccessful, a repeat Caesarean section is performed.

Occasionally, medical history or circumstance can make VBAC a poor choice for women – a repeat Caesarean section would be recommended in this case. Ask your health care professional if a VBAC is right for you.

What are the benefits of having a vaginal birth if I had a Caesarean before?

  • Lower risk of infection (0.7% risk for vaginal birth compared to 1.4% risk with a cesarean).
  • A shorter stay in hospital (1-2 nights instead of 3 or more).
  • Avoiding another scar on your uterus. This is important if you are planning on a future pregnancy. The more scars you have on your uterus, the greater the chance of problems with a later pregnancy.
  • A faster recovery, making it easier to breastfeed, look after other children and return to your usual level of activity.
  • Less pain overall. Labour may be painful, but if you deliver vaginally, the pain is mostly over once your baby is born.
  • Reduces blood loss.
  • Eliminates complications related to surgery.
  • Lower risk of blood clots following delivery.
  • Lower risk for complications from anesthetic.

Is a trial of labour safe?

The risk of a major complication after a previous Caesarean is low and not that different for women planning a vaginal birth (1.9%) compared to those planning another Caesarean (1.4%).

A Caesarean section leaves a scar on the uterus. This is a weak area and can tear during labour called a uterine rupture. This rare but serious complication is hard to predict for any woman having a baby but is slightly more likely to occur (0.7%) among women who planned a VBAC compared to those who planned a Caesarean (0.3%). These complications are usually recognized quickly and treated in hospital.

Research in British Columbia found it was extremely rare (0.05%) for a baby to experience life-threatening complications after a VBAC or a planned Caesarean section. Other complications that can cause concern (admission to an intensive care nursery, help with breathing, low overall health rating at birth) are also uncommon. In fact, the rates are similar for women having a VBAC (0.6%) or Caesarean (0.5%).

Is an epidural still an option?

Yes, an epidural is frequently used during a VBAC.

What if I have a vaginal tear during my VBAC? Aren’t I at risk of ongoing problems and pain?

Less than 5% of women having a VBAC will have a major vaginal tear.

It’s common to worry about problems associated with a vaginal tear. Women are concerned about pain in the genital area and problems with sexual relations or with urination or bowel movements. Fortunately, for the few women who do experience a vaginal tear, these problems are temporary and studies have shown that three months after giving birth, they are fully resolved.

I’m in my late 30s. Does my age make it more risky for me to give birth vaginally after a previous Caesarean?

There is an increased risk of complications in pregnancy and birth for all women over the age of 35 compared to younger women. For women over 35 planning a VBAC, the risk of major complications is slightly higher than in younger mothers.

I wasn’t able to have a vaginal delivery last time. Isn’t it likely to be the same this time?

Not necessarily. Approximately three-quarters (78%) of Saskatchewan women that had a trial of labour during 2012 or 2013 had a vaginal birth. Women that have had at least one previous vaginal delivery are even more likely to be successful.

What else do I need to know?

  • To reduce risks, spontaneous labour is preferred over induced labour for VBAC.
  • Your doctor will review your surgery record and discuss whether a trial of labour is right for you.
  • A thorough discussion should be had with your health care provider to determine if you are an appropriate candidate for a VBAC. There are important risks and circumstances to consider and it is important that you discuss these with your physician or midwife.