Vaginal Birth after a C-section: What to Expect

Did you deliver your last child via a Cesarean (C-section), and are now expecting or planning another pregnancy? If so, you may not know about your options for vaginal birth after C-section (VBAC).

At NY Midtown OB/GYN in Manhattan and Westchester, New York, our team of experts wants you to have all the facts. This includes being educated about when C-sections are needed and what your options are for each pregnancy and delivery.

VBAC is still classed under “high-risk obstetrics,” but that doesn’t mean you shouldn't be able to consider the option. You just need to have an open and honest conversation with your medical team about the chances of a successful VBAC before making your decision.

Cesarean rates in the United States

The Cesarean birth rate has risen from 7% in 1990 to 21% today. Many different reasons are given for this figure; women’s personal choice is only one of them. Specific hospitals and doctors may prefer to err on the side of caution when recommending a C-section. 

In one study of women who had previously delivered by C-section, many reported that their hospital or provider had a policy in place mandating all women with a prior Cesarean must have a repeat Cesarean.

What modern-day VBAC looks like

The original Cesarean section involved a vertical incision made from the top of the belly to the pubic bone. This type of incision (often called a Classical incision) has up to a 12% risk of resulting in uterine rupture under the strain of normal labor. This is why mothers who have had a Classical incision are often counseled to have a repeat Cesarean. 

Of course, the Classical incision is not the standard used today; it’s reserved for extreme emergencies when getting the baby out quickly is the most important thing. The majority of Cesarean births today allow women to deliver via a low transverse incision.

The low transverse incision goes through both the lower abdominal wall and the uterine wall, right about at the bikini line. It leaves a small scar, but it is usually hidden in a small crease or by your pubic hair.  

Having a low transverse incision doesn’t completely erase the risk of uterine rupture, but it does lower it to less than a 1% chance. Knowing this can help you make the best decision for yourself and your baby when it comes to planning your delivery.

Factors that affect VBAC success

There are multiple factors to consider before opting for VBAC. Most are factors that also count as high-risk pregnancy indicators, which can act as multipliers when calculating VBAC risk:

• Your age: being over 40 reduces your chances of a successful VBAC
• Your height: being shorter than 154 cm decreases the chance of successful vaginal delivery
• Your weight: obesity during pregnancy decreases the chance of a successful VBAC

Other factors that can make you a poor candidate for VBAC include previous history of failed trial of labor or a previous complicated vaginal delivery.

What to expect from your VBAC

If you decide on a VBAC after consulting with your doctors, we proceed with that as your preferred birth plan. Attempting a VBAC is often referred to as a “trial of labor after Cesarean”, or TOLAC.

As your labor proceeds, you are given every opportunity and encouragement. We monitor you and your baby closely, as with any high-risk delivery, to reduce risk to you and your baby.. If at any point, you decide you want to stop the TOLAC, or if medical concerns arise, we are ready to deliver your baby through a repeat Cesarean section. 

If you still aren’t sure if VBAC is right for you, contact us for more information. You can schedule a consultation with our team today by calling the location closest to you or booking online today.