How to Prepare for Vaginal Birth After Cesarean

Vaginal birth after cesarean delivery (VBAC) is giving birth vaginally after previously delivering a baby through a cesarean section (C-section). You and your health are provider will discuss your options and whether you may be a good candidate for VBAC.

What are my options?

After a cesarean delivery, your options for future deliveries may include:

• Scheduled repeat cesarean delivery. This is done in a hospital with an operating room.
• Trial of labor after cesarean (TOLAC). A successful TOLAC results in a vaginal delivery. If it is not successful, you will need to have a cesarean delivery. TOLAC should be attempted in facilities where an emergency cesarean delivery can be performed. It should not be done as a home birth.

Talk with your health care provider about the risks and benefits of each option early in your pregnancy. The best option for you will depend on your preferences and your overall health as well as your baby’s.

What should I know about my past cesarean delivery?

It is important to know what type of incision was made in your uterus in a past cesarean delivery. The type of incision can affect the success of your TOLAC. Types of incisions include:

• Low transverse. This is a side-to-side cut low on your uterus. The scar on your skin looks like a horizontal line just above your pubic area. This type of cut is the most common and makes you a good candidate for TOLAC.
• Low vertical. This is an up-and-down cut low on your uterus. The scar on your skin looks like a vertical line between your pubic area and belly button. This type of cut puts you at higher risk for problems during TOLAC.
• High vertical or classical. This is an up-and-down cut high on your uterus. The scar on your skin looks like a vertical line that runs over the top of your belly button. This type of cut has the highest risk for problems and usually means that TOLAC is not an option.

When is VBAC not an option?

As you progress through your pregnancy, circumstances may change and you may need to reconsider your options. Your situation may also change even as you begin TOLAC. Your health care provider may not want you to attempt a VBAC if you:

• Need to have labor started (induced) because your cervix is not ready for labor.
• Have never had a vaginal delivery.
• Have had more than two cesarean deliveries.
• Are overdue.
• Are pregnant with a very large baby.
• Have a condition that causes high blood pressure (preeclampsia).

Questions to ask your health care provider

• Am I a good candidate for TOLAC?
• What are my chances of a successful vaginal delivery?
• Is my preferred birth location equipped for a TOLAC?
• What are my pain management options during a TOLAC?

Where to find more information

• American Congress of Obstetricians and Gynecologists: www.acog.org  
• American College of Nurse–Midwives: www.midwife.org  

Summary

• Vaginal birth after cesarean delivery (VBAC) is giving birth vaginally after previously delivering a baby through a cesarean section (C-section).
• VBAC may be a safe and appropriate option for you depending on your medical history and other risk factors. Talk with your health care provider about the options available to you, and the risks and benefits of each early in your pregnancy.
• TOLAC should be attempted in facilities where emergency cesarean section procedures can be performed.