Vaginal Birth After Cesarean (VBAC)

For most women, pregnancy and childbirth are natural life events. However, some women require a cesarean section (C-section) for various reasons. If a woman wishes to have a vaginal birth after a previous C-section, this is referred to as Vaginal Birth After Cesarean (VBAC).

What is VBAC?

VBAC is the term used when a woman gives birth vaginally after a previous cesarean section.

What are the Benefits of VBAC?

✔ Higher chance of future uncomplicated vaginal births
✔ Shorter recovery time and reduced hospital stay
✔ Less abdominal pain after birth
✔ Avoidance of major surgery

Is VBAC Likely to Be Successful?

• Overall, 75% of women (3 out of 4) who attempt a VBAC have a successful vaginal delivery.
• If a woman has had a vaginal birth before or after her C-section, her chances of a successful VBAC increase to 90%.
• Short maternal height, high BMI, and increased maternal age are associated with a lower chance of successful VBAC.
• If the baby is estimated to weigh over 4 kg, the chance of a successful VBAC decreases.

What are the Risks of VBAC?

❌ Emergency C-section – Around 25% of women who attempt VBAC may require an emergency cesarean due to slow labor progression or fetal distress.
❌ Higher risk of needing a blood transfusion
❌ Increased risk of uterine infection – Women who choose VBAC have a 1% higher chance of needing a blood transfusion or developing a uterine infection than those opting for a scheduled repeat C-section.
❌ Risk of uterine scar rupture – The scar from the previous C-section may weaken and tear (uterine rupture). This is rare (occurs in 0.2%–0.8% of cases), but if it happens, it can have serious consequences for both mother and baby. Inducing labor increases this risk.
❌ Risk of neonatal brain injury – There is a 0.2% chance (2 in 1,000) of brain injury due to oxygen deprivation during VBAC. This risk is slightly higher than in a planned repeat C-section (0.1%).

The risks increase if a VBAC attempt is unsuccessful, making a repeat emergency C-section necessary.

When is VBAC Not Recommended?

A repeat C-section is a safer choice in the following cases:
✔ Two or more previous C-sections
✔ Previous uterine rupture
✔ High vertical (classical) uterine incision
✔ Pregnancy complications requiring a C-section

How Can You Increase Your Chances of a Successful VBAC?

✔ Support during labor – Emotional and physical support can help manage pain and improve labor progression.
✔ Stay active and mobile – Movement and upright positions help the baby descend into the pelvis and reduce labor pain.

When Should You Go to the Hospital?

Women attempting a VBAC should wait until contractions are regular (every 5-10 minutes, lasting 1 minute each)before heading to the hospital.

However, immediate hospital admission is necessary if:
✔ There is vaginal bleeding
✔ The water breaks
✔ There is severe abdominal pain unrelated to contractions
✔ There are concerns about the baby’s movements

VBAC should always take place in a hospital setting to allow for immediate C-section if needed.

What Happens During Labor if You Are Attempting VBAC?

Due to the previous C-section scar, labor management for VBAC differs from a first-time vaginal birth.

• Continuous fetal monitoring – The baby’s heart rate is monitored electronically to detect any signs of distress. This can be done while sitting or standing.
•  Labor progression monitoring – Slow progress may indicate a potential scar rupture. If necessary, a low-dose oxytocin infusion may be given to stimulate contractions, but this will be carefully assessed.
•  Pain relief options – Epidural anesthesia is an option, but it can slow down labor and increase the chance of needing a C-section.
•  Alternative pain relief methods – Breathing techniques, relaxation, massage, pethidine injection (a sedative), and water birth may help with pain management.

While home births or water births for VBAC lack sufficient safety data, some women choose them to cope with labor pain. In such cases, fetal heart monitoring must be done at regular intervals.

What If Labor Does Not Start Naturally?

If labor does not begin by 40-41 weeks, the doctor will discuss the following options:
✔ Waiting for spontaneous labor
✔ Opting for a repeat C-section
✔ Labor induction is NOT recommended after a C-section, as it increases the risk of uterine rupture by 2-3 times.

Uterine rupture can have severe consequences, including:

• Neonatal or maternal death
• Neurological damage to the baby (30% of cases)
• Emergency hysterectomy
• Severe hemorrhage and organ injury (e.g., bladder damage)

Expert VBAC Care

The Thely Clinic team has years of experience in monitoring and managing VBAC. They will support you throughout your pregnancy and delivery, helping you make the best decision for you and your baby.