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VBAC FAQ

After a cesarean, most women have two choices for future births: a vaginal birth after cesarean (VBAC) or a repeat cesarean section (RCS). There is a lot of misinformation about these two options. Let’s review some quick facts.

Per the American College of Obstetricians and Gynecologists, VBAC is a reasonable and appropriate choice for most women with one prior cesarean and for “some women” with two prior cesareans (1). Being pregnant with twins, going over 40 weeks, having an unknown or low vertical scar, or suspecting a “big baby” should not prevent a woman from planning a VBAC (1).

Research on uterine scar thickness (2) and single vs. dual layer suturing (3) are on-going as the studies completed thus far are not strong enough to provide conclusive support for specific actions.

VBAC is successful 75% of the time (4-8). Successful VBACs have lower maternal complication rates than planned repeat cesareans which have lower rates than VBACs that end in a cesarean (6), otherwise known as cesarean birth after cesarean or CBAC.

Uterine rupture is the major concern in terms of VBAC and while it can be catastrophic, it is rare (9). As the National Institutes of Health asserts, “VBAC is a reasonable and safe choice for the majority of women with prior cesarean. Moreover, there is emerging evidence of serious harms relating to multiple cesareans… The majority of women who have TOL [trial of labor] will have a VBAC, and they and their infants will be healthy. However, there is a minority of women who will suffer serious adverse consequences of both TOL and ERCS” (10).

Permitting labor to begin naturally after one prior low transverse (“bikini cut”) cesarean carries a 0.4% risk of rupture which can increase upon labor augmentation or induction (6). These rates are similar to other serious obstetrical emergencies such as placental abruption, cord prolapse, and shoulder dystocia.

Cesarean risks, including placenta accreta, hysterectomy, blood transfusion, and ICU admission, increase with each surgery (11); whereas after a successful VBAC, the future risk of uterine rupture, uterine dehiscence, and other labor related complications significantly decrease (12).

With each option, the risk of maternal death is very low: ERCD at 13.4 per 100,000 versus 3.8 per 100,000 for TOL (10). The evidence quality on perinatal mortality (infant death within 28 days of birth) is low due to the wide range of rates reported by various studies (11).

45% of American women are interested in the option of VBAC (14), yet 92% have a RCS (15). Some women chose their RCS or it was medically necessary. Others felt like they didn’t have much of a choice for numerous reasons including hospital VBAC bans (16); immense social pressure; or the misrepresentation of VBAC risks (17).

Our repeat cesarean rate feeds America’s rising total cesarean rate, currently at 32% (18). Declercq (2009) links our high cesarean rate with our high maternal mortality rate relative to other developed countries (19).

Throughout America, hospital and doctor attended VBACs are legal (20). In some states, it is legal for a midwife to attend an out-of-hospital VBAC. However, of the women interested in VBAC, 57% are unable to find a supportive care provider or hospital (14). This is due primarily to the 1999 ACOG recommendation that a doctor be “immediately available” to perform a cesarean, yet they provided no clear definition or standard for where the obstetrician and/or anesthesiologist should be or what they could be doing (1).

As a result, hospitals developed their own definitions producing differing VBAC protocols and requirements. The most severe variety was the institution of formal VBAC bans in 28% of all American hospitals and de facto bans in an additional 21% (21), disproportionally affecting women living in rural areas. The 2010 ACOG guidelines addressed these bans and confirmed: “restrictive VBAC policies should not be used to force women to undergo a repeat cesarean delivery against their will” (1). Hopefully VBAC will become a viable option to the many women who desire it (22).

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Ready to learn more? Check out the list of articles and categories to your left.

Want more information on planning a VBAC? Go here.

Want to help get this basic information about post-cesarean birth options out to the public? The VBAC Facts Micro Brochure are premium 100lb 3.5″ x 2″ matte finish folding business cards that do just that. The front features space for your contact information and the inside contains much of the important facts you just read. Due to their small size, they are convenient to carry and distribute without having bulky pamphlets in your pocket or purse. Learn more and purchase.

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1. American College of Obstetricians and Gynecologists. (2010). ACOG Practice Bulletin No. 115: Vaginal Birth After Previous Cesarean Delivery. Washington DC.

2. Kmom. (2009, February 12). Ultrasound Measurement of Cesarean Scar Thickness. Retrieved from Well Rounded Mama: http://wellroundedmama.blogspot.com/2009/02/ultrasound-measurement-of-cesarean-scar.html

3. Humphries, G. (2004, June 14). The Suture Debate. Retrieved October 1, 2009, from International Cesarean Awareness Network: http://www.ican-online.org/vbac/the-suture-debate

4. Coassolo, K. M., Stamilio, D. M., Pare, E., Peipert, J. F., Stevens, E., Nelson, D., et al. (2005). Safety and Efficacy of Vaginal Birth After Cesarean Attempts at or Beyond 40 Weeks Gestation. Obstetrics & Gynecology, 106, 700-6.

5. Huang, W. H., Nakashima, D. K., Rumney, P. J., Keegan, K. A., & Chan, K. (2002). Interdelivery Interval and the Success of Vaginal Birth After Cesarean Delivery. Obstetrics & Gynecology, 99, 41-44.

6. Landon, M. B., Hauth, J. C., & Leveno, K. J. (2004). Maternal and Perinatal Outcomes Associated with a Trial of Labor after Prior Cesarean Delivery. The New England Journal of Medicine, 351, 2581-2589.

7. Landon, M. B., Spong, C. Y., & Tom, E. (2006). Risk of Uterine Rupture With a Trial of Labor in Women with Multiple and Single Prior Cesarean Delivery. Obstetrics & Gynecology, 108, 12-20.

8. Macones, G. A., Cahill, A., Pare, E., Stamilio, D. M., Ratcliffe, S., Stevens, E., et al. (2005). Obstetric outcomes in women with two prior cesarean deliveries: Is vaginal birth after cesarean delivery a viable option? American Journal of Obstetrics and Gynecology, 192, 1223-9.

9. National Institutes of Health. (2010, June). Final Statement. Retrieved from NIH Consensus Development Conference on Vaginal Birth After Cesarean: New Insights: http://consensus.nih.gov/2010/vbacstatement.htm

10. Guise, J.-M., Eden, K., Emeis, C., Denman, M., Marshall, N., Fu, R., . . . McDonagh, M. (2010). Vaginal Birth After Cesarean: New Insights. Rockville (MD): Agency for Healthcare Research and Quality (US). Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK44571/

11. Kamel, J. (2012, Apr 3). Confusing fact: Only 6% of uterine rutpures are catastrophic. Retrieved from VBAC Facts: http://vbacfacts.com/2012/04/03/confusing-fact-only-6-of-uterine-ruptures-are-catastrophic/

12. Silver, R. M., Landon, M. B., Rouse, D. J., & Leveno, K. J. (2006). Maternal Morbidity Associated with Multiple Repeat Cesarean Deliveries. Obstetrics & Gynecology, 107, 1226-32.

13. Mercer, B. M., Gilbert, S., Landon, M. B., & Spong, C. Y. (2008). Labor Outcomes With Increasing Number of Prior Vaginal Births After Cesarean Delivery. Obstetrics & Gynecology, 11, 285-91.

14. Declercq, E. R., & Sakala, C. (2006). Listening to Mothers II: Reports of the Second National U.S. Survey of Women’s Childbearing Experiences. New York: Childbirth Connection. Retrieved from Childbirth Connection: http://www.childbirthconnection.org/article.asp?ck=10068

15. Osterman, M. J., Martin, J. A., Mathews, T. J., & Hamilton, B. E. (2011, July 27). Expanded Data From the New Birth Certificate, 2008. Retrieved from CDC: National Vital Statistics Reports: http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_07.pdf

16. Kamel, J. (2010, July 22). VBAC ban rationale is irrational. Retrieved from VBAC Facts: http://vbacfacts.com/2010/07/22/vbac-ban-rationale-is-irrational/

17. Kamel, J. (n.d.). Scare tactics. Retrieved from VBAC Facts: http://vbacfacts.com/category/vbac/scare-tactics/

18. Menacker, F., & Hamilton, B. E. (2010, March). Recent Trends in Cesarean Delivery in the United States. Retrieved from Center for Disease Control and Prevention: http://www.cdc.gov/nchs/data/databriefs/db35.htm

19. Declercq, E. R. (September, 2009). Birth by the numbers. Retrieved from Orgasmic Birth: http://www.orgasmicbirth.com/birth-by-the-numbers

20. Kamel, J. (2009, February 28). Is VBAC illegal? Is homebirth illegal? Retrieved from VBAC Facts: http://vbacfacts.com/2009/02/28/is-vbac-illegal/

21. International Cesarean Awareness Network. (2009, February 20). New Survey Shows Shrinking Options for Women with Prior Cesarean. Retrieved from ICAN: http://www.ican-online.org/ican-in-the-news/trouble-repeat-cesareans

22. Kamel, J. (2010, March 9). American women speak about VBAC. Retrieved from VBAC Facts: http://vbacfacts.com/2010/03/09/american-women-speak-about-vbac/

Last revised: 11/11/12

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126 comments to VBAC FAQ

  • Danver Johnson

    I have had 2 c-sections one 10-10-03 and another ione 11-28-05. I am currently 34 weeeks pregnant and had to move to a different state of my prenatal care because my father passed away where i was at was going to let me do a VBAC after the 2 and now in minnsota i cannot find a hospital that will let me do a VBAC. If anyone knows of a hospital or any suggestions for me to do a vaginal birth or know of any hospital or Dr. in SE MN to help me plese let me know ASAP please!
    IN DESPERATE NEED,
    Danver Johnson

    • Jen Kamel

      Danver,

      Unfortunately, I don’t know of any care providers in that area of the country.

      If you are on Facebook, I welcome you to join the VBAC Facts Community. You might be able to get a referral for a supportive care provider there. Also check out this article on how to find a supportive care provider.

      Warmly,

      Jen

    • Danver,

      Did you have any luck finding a care provider? I live in Duluth, MN and would be happy to help you in what ever way I can. Jen you have my permission to give her any contact info you have for me.

      Blessings,
      Serena

  • alicia clarisse

    Jen Kamel. Is there any hospitals in Riverside or San Bernardino County that will deliver me VBAC if I don’t have a doctor who agrees with it? My doctor and primary hospital ban vbacs. Please help!!!

  • FYI, If you live somewhere that doesn’t allow a vbac in the hospital, some other options for you might be to consider:

    1. a birthing center with midwives – they would work with you to have a vbac, if in the end it wasn’t possible for you, they have plans in place for transferring you to a hospital if needed. (most vbacs are successful in my limited doula experience of about 160 births, many of which are vbacs)

    2. a homebirth with midwives – same transfer possibility as above if needed.

    3. having a montrice or doula for your labor and delivery. Have the doula meet you at home and stay home through all of early labor and well into transition, don’t go to the hospital till you are 8+ cm. By then they could see how well you are doing and let you keep trying. Also have printed information from ACOG with you on the safety of vbac.

    4. find a neighboring city that has a hospital and vbac friendly docs and rent a hotel for your labor, then go to that hospital for the delivery.

    Just some ideas. Many people choose hospital care because of insurance reasons, but you may find out that insurance will cover all or portions of out of hospital care too, under certain circumstances. Also it’s much less expensive to have a baby in a birth center or at home with midwives, so AT LEAST go check out the other options in your community.

    Hope something here will help!

    Blessings,

    Tanya Phillips, Certified Doula,
    Montrice, IBCLC, & Placenta Encapsulator
    Austin, TX

  • Ed

    Goodnews, Flagstaff Medical Center have joined with docs at North Country OB/GYN and Flagstaff OB/GYN are now offering TOLAC-VBAC

  • Renee

    I posted on this site a few months ago about wanting to vbac after finding out why I had the c section the report listed gestational diabetes (diet controlled), failure to descend/progress, and cpd as the reasons. I was just put on glyburide for my gd at 32 weeks, I took the vbac class and my doc where i am now is suddenly saying because of the meds and reason for the last c section that a vbac is least likely to be successful. I’m not sure what decision to make he asked me right then if I wanted I repeat I said ill talk to my husband who left it up to me so I told the doc I want to wait to decide. I dont know if I trust the doc I have read reviews of him being very pro c section supposedly doing 7 in one night. Should I get a second opinion?

  • lilly

    what do you think of a vbac 14 mths after a c sec is it to soon?

  • Holly

    Hello,

    I am new to this website just discovered it tonight thanks to Birth Nerds :)
    https://www.facebook.com/pages/Birth-Nerds/160024657401484?ref=ts&fref=ts

    However I’m kind of new to all of this. My first pregnancy ended with a c-section. One that i didn’t want but choose to have due to my sons health. Right now we are about 10 and a half weeks along with number 2. I really wanted a vaginal birth the first time and was really disappointed that we didn’t have one but my son was more important to me. My question is how does having type 2 diabetes play a role in having a VBAC of course as long as things go fine until the end? I can’t find any info on it. Maybe I’m not looking right. My concern is that due to the diabetes my doc doesn’t want me to go until 40 weeks. It increases the risk of having a still born. However according to what I’ve read so far about VBACs it’s not a great idea to induce them. I would really appreciate any info you can give me on this. My son was a large baby. Partially due to the diabetes and we have large babies that run in our family, both sides. I have not seen my regular Ob/gyn yet. So we have not discussed anything yet. I want to give myself the best possible chance to have a VBAC from the beginning.

    Thanks in advance!

    P.S. The hospital I want to use again is Kadlec Medical Center in Richland, WA 99354.
    If you know if they support VBACs also would you let me know.

  • sydnie

    I’m 39weeks and 3 days Im planning on having a vbac but I’m not sure how long I should wait before I decide on a c-section…I’m only dialated to a 1½ I really don’t want to have to go through all the hassle of a c-section

    • Jen Kamel

      Sydnie,

      The fact that you are 1.5 cm dilated at 39 weeks is great! If you want a VBAC, the American College of OB/GYNs says that going beyond 40 weeks shouldn’t prevent a woman from planning a VBAC. What does your care provider say? I’m also posting your question on my Facebook profile and page so you can get feedback from other people.

      Warmly,

      Jen

  • kimberly

    So glad I found this site. After just doing a google and being scared to death. I am waiting for my dr at Evans Community Hospital to get my old op report. Thank you for your site.

  • iliana

    I’ve called several doctors in los angeles, ca that support vbacs but none take Medical. Does anyone know is that will be the case for all doctors? do none take medical?

  • Alexis Shields

    I have been stressing myself out so much over what I should do, I have had three kids so far two vaginal and my last C-section and im pregnant again (due August 10) My OB told me that I can try for a Vbac but im still worried im just not sure if I should try it or go ahead and schedule another C-section

    • Jen Kamel

      Alexis,

      Women with a history of vaginal delivery have excellent VBAC success rates. Ultimately, you have to weigh the risks and benefits of VBAC vs. repeat cesarean and decide what would be the best choice for you. These two documents published by ACOG and BC Women’s Cesarean Task Force provide a good review of your options. I also highly recommend the various documents and videos related to the National Institutes of Health 2010 VBAC Conference. If you want even more detail, check out my class.

      To get you more feedback, I’ve posted your question on Facebook.

      Hope this helps!

      Jen

  • Silvia

    I have had for c-sections with the last one being the worst
    What are my hopes for a future pregnancy??
    I recently just liked your fb page , is it possible you guys can ask for a feedback?
    Are there any mamas out there with a story on trying a hba4c???
    Btw all my c-sections were repeat after the first one , as soon as I would ask about vbac they turned me down and scared too much to just go with a repeat c-section :(
    TIA!

  • fatouma

    Hi,

    I live in Columbia,mo and i was wondering if you know of any Vbac friendly providers in that area?

    • Jen Kamel

      Hi Fatouma!

      I don’t maintain a list of providers, but I list many resources here that may be able to help you.

      I also shared your question here so you can get more referrals.

      Best,

      Jen

  • Silvia

    Jen thanks so much , I didn’t even notice there were some mamas that replied :(
    Unfortunately here in Las Vegas nv no doctor will take me in
    But have found some midwives who are so willing to help out :)
    I will not lie only reason I would prefer a hospital is for the epidural but ill do whatever it takes!

  • Ellie Moran

    I am not sure what I should do. I am 24 weeks with my second baby.Wh my first pregnancy I had high blood pressure and gestational diabetes. My OB induced me at 38 weeks to not put any further stress on my baby. He broke my water 12 hours after starting the process and I was only dilated 1. I wanted to have no medication. I wanted to prove to everyone I could do it. 12 hours after he broke my water he checked me (I was checked in between) and I was still a 1. He told me that I could get an epidural and it may help me relax enough to dilate. I was having “fantastic” contractions. He said I was having a baby today and asked if I understood what he was saying. He knew my biggest fear was a csection. He continued to explain that if I did opt for an epidural and still didn’t dilate and weh to do a csection they would need to switch to a spinal block and if they couldn’t manage that he would have to put me under in which case my husband couldn’t be in the operating room. Since a csection was by biggest fear I said no to the epidural. 6 1/2 hours later still at a 1 and done with being in labor I had a csection. So this time my OB said he would allow me to attempt a vbac if I wanted but I wasn’t a good candidate. At the time I opted to plan a csection. I could plan my leave and thought it sounded fine. Now I’m starting to freak out! I explained it to my husband like going into the situation sober this time. I have encouraging friends who have been talking up a vbac and one who would even be there if i decided to do so. I just can’t decide what would be best. My main concern is my very clingy 2 1/2 year old who won’t understand wcmpletely why she can’t be on me and I don’t want to cause more unstable emotions for her right after we have a new baby. Help?!?!

    • Jen Kamel

      Ellie,

      The only person who can make this decision is you together with a VBAC supportive health care provider. I encourage you to get a copy of your medical records and your operative report and review it with a VBAC supportive provider.

      I include many resources here which you may find helpful.

      I have shared your comment here to get additional feedback. You are also welcome to join the VBAC Facts Community.

      I hope this helps!

      Jen

  • Hi Jen. I was talking with one of my doula clients today and she is interested in having a VBAC after 2 C-sections. She has herniated disks at L4-L5 and L5-S1. Can she still have a VBAC? She did have surgery on her back. Any info or facts for her would be highly appreciated? Thanks. Chris

  • Tara

    It’s too bad the ACOG can’t enforce some sort of legal punishment on hospitals that have “restrictive VBAC policies that basically force women to undergo a repeat cesarean delivery against their will.” I live in a rural town where the closest hospital that will allow VBAC is 3 hours away. I had a successful VBAC and drove the 3 hours, but not everyone is able to do that. I have a lot of friends who end up having RCS because they can’t make the commute. It is so infuriating to feel like I have NO choice when it comes to my body. When will the medical community stand up and take our side instead of the side where the money is?

  • Brittany

    Hey Jen,
    I am very interested in a VBAC! I had one bikini cut c section July 2013 with no complications and I’m now 12 weeks pregnant. I was going to do a home birth with the first baby but he was breech. No matter what we tried he would not turn and I was told I had to have a c section. My doctor now is telling me they don’t do VBACs. My issue is I do not have money to pay out of pocket and my only insurance is Medicaid. I live in South Texas in Hidalgo County and haven’t found a provider near me who does VBACs and accepts Medicaid. I’m desperate for any resources you can provide!

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