Can I Have a Vaginal Birth After a C-Section?

Nearly one out of every seven babies in the US is born by Cesarean section, meaning that the baby is delivered through an incision made in the mother’s lower abdomen and uterus,  instead of vaginally. Once you have a C-section, can you deliver vaginally in the future? The answer is: it depends....

At Physicians for Women in Madison, Wisconsin, our team of women’s health specialists including board-certified Obstetricians and certified nurse midwives, can help you decide if a Vaginal Birth After Cesarean (VBAC) is safe for you and your baby. 

Why were VBACs traditionally discouraged?

The history of the first recorded Cesarean sections in many cultures across the ancient world is surrounded by mystery, drama and likely, misinformation. Modern day Cesareans were initially performed by making a vertical lower abdominal/ uterine incision to deliver a baby, called, unsurprisingly,  a Classical incision. Today, a classical Cesarean section is reserved for certain obstetric conditions. An example is for an emergent or life-threatening situation for either the mother or baby, where the speed of the delivery provides urgent access to the baby or allows the mother’s rapidly deteriorating health to be quickly addressed. Pregnant women with a previous Cesarean through a Classical incision are at risk for uterine rupture should they labor, and therefore a planned repeat cesarean delivery is recommended and internationally endorsed, including by the American College of Obstetricians and Gynecology (ACOG). The Society for Maternal Fetal Medicine (SMFM) reports a 4-9% overall risk of uterine rupture with a history of a prior classical cesarean incision. If uterine rupture occurs, it can be life-threatening for both mother and baby, with a high likelihood for massive hemorrhage requiring transfusions, emergency hysterectomy,  ICU and NICU care.

Low Transverse C-sections

Fortunately, the majority of Cesarean births today are done via a low transverse incision on both the lower abdominal wall and uterus. The incision is made as low as possible, often right  along the bikini line across the lower abdomen, and right above the pubic hairline. Although the incidence of uterine rupture is not zero after this type of incision, it is significantly lower (0.5-1.2%). Women, therefore, with a history of a low transverse Cesarean section have the option to a trial of labor should they desire a vaginal birth. This is sometimes called a TOLAC (Trial of Labor After Cesarean). Depending on the circumstances that prompted the first Cesarean section, a woman has the choice of scheduling a repeat Cesarean delivery and not choosing a trial of labor.

Obstetricians often use a VBAC Calculator to estimate their patient’s potential success for a vaginal delivery after having had a prior Cesarean section delivery. [https://www.babymed.com/pregnancy-tools/vbac-vaginal-birth-after-cesarean-calculator#]

Factors that play a role in predicting success include a patient’s age, height, weight, race, history of previous vaginal deliveries and the indication for Cesarean delivery.

To learn more about your options and if a TOLAC could be possible for you, get in touch with the experts at Physicians for Women. You can schedule a consultation by calling 608-218-4835, or book an appointment online.