VBAC: What Is It and Things to Consider Before Pursuing
People who’ve had a cesarean birth (c-section), where the baby is born through an incision in the belly and uterus, can pursue having their next baby vaginally. This is what’s referred to as a vaginal birth after a cesarean (VBAC).
There are a number of factors that determine the success rate of a VBAC, and while nothing is ever guaranteed in birth, the majority who attempt a VBAC are able to give birth vaginally. Roughly 60-80% of individuals who attempt a VBAC for their next delivery are able to have a vaginal birth.
However, the likelihood of a VBAC depends in part on the cause of the original c-section and VBACs come with one major risk, so it’s important to understand the pros and cons of opting for one and consult with a VBAC friendly provider to discuss your options and personal risk factors for birth. In this guide, we’ll cover the benefits and risks of a VBAC, repeatable and non-repeatable factors impacting VBAC rates, different considerations, and how to physically prepare for a VBAC.
What Is a VBAC Birth?
VBAC, or vaginal birth after cesarean (c-section), is when a person has a vaginal birth after previously having a c-section. A 2VBAC is a second vaginal birth after cesarean and a VBA2C is a vaginal birth after two cesareans.
There are many factors that come into play when determining if a VBAC is an option for you.
Folks desire a vaginal birth after cesarean for all sorts of reasons. With a VBAC as compared to a c-section, there is no surgery and therefore a shorter hospital stay. Oftentimes folks have always envisioned a vaginal birth and want to have the experience for themselves. There’s also the perception of a shorter recovery and quicker return to daily activities, although that’s a common misconception. While recovery time differs with each individual birth, there’s no clear rule of thumb on whether those who birth via cesarean or vaginally recover faster.
Aside from personal preference, a VBAC is something you may want to consider if you’re planning on having additional pregnancies as the risk of certain conditions like placenta accreta increases with multiple cesarean births.
TOLAC vs. VBAC
A TOLAC, or trial of labor after cesarean, is when an individual who has previously had a c-section undergoes labor for any length of time, regardless of whether this results in another c-section or a vaginal birth.
Trial of labor will not always end in a vaginal birth, but TOLAC itself has a number of benefits. According to a 2020 study in BMC Pregnancy Childbirth, these benefits include reduced risk of bleeding, infection and thrombosis as well as earlier discharge times and reduced risk of uterine rupture.
Benefits of a VBAC
When considering your future childbirth, it’s important to weigh the pros and cons of a VBAC with your provider and discuss the factors that increase or reduce your likelihood of having a VBAC. It’s also important to investigate whether your provider is supportive of a VBAC. The International Cesarean Awareness Network has a great list of questions you can bring to your provider to determine whether they’re the right person to care for you based on your goals. Below are a number of benefits associated with a VBAC.
There is less blood loss and you don’t need to undergo surgery.
There’s a potentially shorter recovery time.
Because there is no surgery associated with a VBAC, there’s a lower risk of infections and complications.
VBAC might help you avoid the risks of placental problems that are associated with multiple C-section deliveries, particularly if you’re planning future pregnancies.
You want to experience having a vaginal delivery.
Risk of uterine rupture during a VBAC
The most significant risk of a VBAC is a uterine rupture and understanding the level of risk is important in order to allow yourself to make an informed choice about how you’d like to proceed.
The actual risk of a uterine rupture is less than 1%, with some estimates citing a risk of 1 in 5,700. While the incidence is quite low, the threat associated with a uterine rupture is high. A uterine rupture is life-threatening for both the birthing parent and the baby. In the event of a uterine rupture an emergency C-section is needed to deliver the baby.
In some cases where a uterus ruptures, treatment may involve the emergency removal of the uterus (hysterectomy). This risk plays a role in why many folks pursuing a VBAC opt to birth in a hospital with an Obgyn, however it’s important to note that some home birth midwives will accept clients hoping for a home birth VBAC.
Who is a strong candidate for a VBAC?
A certain set of criteria may indicate that someone is a strong candidate for a VBAC. This typically includes the following:
No previous uterine ruptures, anomalies, or additional uterine scars
No more than 2 low transverse cesarean deliveries
Non-repetitive indication from the previous c-section
Having at least one successful vaginal delivery prior to your C-section increases the probability of a successful VBAC
Relatively low risk pregnancy
Who is not a candidate for a VBAC?
Just as there are factors indicating a strong candidate for a VBAC, there are a number of absolute and relative contraindications for a VBAC. Signs a VBAC may not be recommended include:
Previous uterine rupture
Prior surgeries on your uterus such as fibroid removal
History of two or more c-sections
Attempting a VBAC less than 18 months after your previous delivery
Underlying medical conditions
Circumstances that might affect your baby such as carrying twins or triplets
Previous c-section with a vertical incision
What is a repeatable and non-repeatable factors?
The reason for your original c-section plays a role in determining the likelihood of success of a VBAC. Repeatable factors are factors that are likely to repeat in a future pregnancy and/or birth, resulting in a subsequent c-section. A non-repeatable factor is a factor that is unlikely to prohibit a VBAC because it is unlikely to repeat in a future pregnancy or birth.
What is a repeatable factors?
Repetitive factors are considered to reduce the likelihood of success of a VBAC.
Labor dystocia is a common repeatable factor. Labor dystocia can mean that labor did not progress as expected for any reason. This can mean that the cervix didn’t dilate or that the cervix was fully dilated but the baby was unable to descend. A c-section that occurred for these reasons may be an indication of a lower likelihood of VBAC for a future childbirth.
Additional repeatable factors include a c-section as a result of medical conditions.
What is non-repeatable factors?
A prior c-section due to a non-repeatable factor may indicate a higher likelihood of a future VBAC. Non-repeatable factors typically include c-sections that happened for some reason relating to the baby. These factors include abnormal fetal heart rate or breech positioning.
How to Physically Prepare for a VBAC
If you’re planning to undergo a VBAC, there are things you can do to support your body physically leading up the childbirth. While you only have control over so many factors when it comes to your delivery, there are things you can do to help physically prepare yourself for a successful VBAC.
Exercise During Pregnancy
Staying active during pregnancy is important for so many reasons (unless your healthcare provider specifies otherwise due to a particular medical condition). If you’re considering a VBAC, consistent physical exercise from the start of your pregnancy can help prepare your body for labor.
Exercise doesn’t have to be intense and for many individuals, exercise during pregnancy will look a little different than prior to pregnancy due to changing tolerance to physical activity. If you were exercising prior to pregnancy and are feeling good during pregnancy, you can likely continue doing what you were doing before, incorporating modifications as needed. If you were sedentary before pregnancy, incorporating basic forms of movement like walking, stretching, yoga or swimming is a great place to start.
Stretching During Pregnancy
Stretching during pregnancy will not only make you feel better, but it can help increase flexibility, improve your range of motion, and reduce the risk of injury — all things that can come to your aid during pregnancy, labor, and delivery.
Some of the most beneficial types of stretching that can help you prepare for a VBAC include:
Hip openers: These create more mobility in the hips and can help support your body in labor and birth.
Pelvic Tilts: Pelvic tilts serve as a core strengthening exercise and take stress off of your low back. You can perform these in bed or while standing in line in the grocery store.
Mid and low back stretches: In addition to relieving tension, simple back stretches like “thread the needle” and “open-book” can help improve rib cage mobility, creating more space for baby to find an optimal position for labor.
Quadriceps and hip flexor stretches: In addition to helping with overall physical performance, balance, and stability, quadriceps and hip flexor stretches can also help support flexible and open hips.
Foam rolling your glutes and inner thighs: Carrying tension surrounding the pelvis is common during pregnancy. This tension can impede the mobility of your pelvis, hips and lumbar spine, impacting your ability to move into various positions during labor. Foam rolling is a great way to address soft tissue restrictions around the pelvis.
Working with a pelvic floor physical therapist
Everybody is different and everyone needs something slightly different to support their pregnancy, birth and recovery goals. While general recommendations like those listed above are helpful, a pelvic floor PT can help you determine which specific physical impairments are unique to your body and how you can address them to minimize the impact on your birth and recovery.
Pelvic floor physical therapy during pregnancy includes a detailed physical exam, education on what you can be doing to support your body at home and manual therapy to address soft tissue and joint restrictions that may have contributed to your previous cesarean birth.
Pelvic floor PT can also help prepare you for postpartum recovery and support you in returning to all the activities you love after baby arrives while minimizing your risk of injury.
Interested in preparing your body for a VBAC? Schedule an appointment with us today.
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.