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Options: VBAC or Repeat C-SectionWhich is safer for my baby: planning a VBAC or a repeat c-section? Which is safer for me: planning a VBAC or a repeat c-section? Which will be safer for me and my babies in any future pregnancies: planning a VBAC or a repeat c-section in this pregnancy? Why is it important to keep options open for VBAC or repeat c-section? How does my right to "informed consent" or "informed refusal" relate to my decision about VBAC vs. repeat c-section? How can I learn more about my specific situation? What if a cesarean is recommended for a new problem that is a not an urgent matter? What are some special scar-related situations when a planned c-section might be recommended, but research has not found any extra risk of having problems with the scar? Are there any factors that do increase my risk of having problems with the scar? Are there any situations where the risk of the scar giving way (uterine rupture) is so high that labor should not be attempted? Does starting labor artificially (induction) affect the likelihood of uterine rupture? Are there any situations where the risk of the scar giving way (uterine rupture) is somewhat lower than average? What factors increase my chances of having a vaginal birth if I prefer VBAC? Though I prefer VBAC, would it ever be wise to plan repeat c-section due to a situation with very low chances of having a vaginal birth? What can I do if fear of repeating another difficult labor is holding me back from considering VBAC? What if deep fear of labor is holding me back from considering VBAC? I've gotten the information, and I'm feeling torn: how can I decide? Which is safer for my baby: planning a VBAC or a repeat c-section?The choice between vaginal birth after cesarean (VBAC, "vee-back") and repeat c-section is sometimes presented in black and white, with some holding the opinion that another cesarean is safest for your baby. It is true that the c-section scar can give way (uterine rupture) during labor and that this is on rare occasions life-threatening for the baby. The decision is not so simple, however, as a c-section also poses risks to babies. This website can help you consider the full range of risks involved when making your decision. You can find detailed information about these risks in Best Evidence: VBAC or Repeat C-Section and Best Evidence: C-Section.Which is safer for me: planning a VBAC or a repeat c-section?Both vaginal birth after cesarean and repeat c-section involve some increased risks to mothers. However, without a clear, compelling and well-supported need for c-section in the present pregnancy, planned vaginal birth is safer overall for you than a planned repeat c-section. With supportive care, 75 or more out of 100 women who plan VBAC give birth vaginally. The others go on to have another cesarean, primarily for reasons that are unrelated to the scar.A planned cesarean offers certain advantages over a cesarean that takes place after labor is underway: a planned cesarean is less likely to involve injury to other organs during surgery, to lead to infection after surgery, and to take an emotional toll. Nonetheless, whether planned or unplanned, cesarean sections are major surgery and involve pain, a post-operative recovery period, and greater risk for mothers in many areas. You can find detailed information about these risks in Best Evidence: VBAC or Repeat C-Section and Best Evidence: C-Section. Which will be safer for me and my babies in any future pregnancies: planning a VBAC or a repeat c-section in this pregnancy?A VBAC in your current pregnancy is the far safer choice for any future pregnancies you may have. Each additional cesarean operation increases the amount of internal scarring (adhesions) and the number of uterine scars. The accumulating scar tissue makes it more and more difficult for the egg to make its proper way from the ovary into the uterus and for the placenta that nourishes the baby to grow and attach normally. These problems can pose life-threatening risks to babies and mothers. The scarring can also pose challenges for future surgical procedures, cesarean or other.A VBAC this time around has other advantages in future pregnancies. If a woman who has a VBAC has more children, she almost always gives birth vaginally and her uterine scar almost never gives way during future labors. Why is it important to keep options open for VBAC or repeat c-section?Dozens of studies involving tens of thousands of women have concluded that planned VBAC is a reasonable choice in nearly all cases. Unfortunately, other factors have come into play on this issue. These include changing cultural views of c-section, VBAC and vaginal birth in general, and fears of legal claims and lawsuits. Many discussions of this matter fail to recognize the full range of risks involved with surgical birth. For these reasons, caregivers and hospitals that offer VBAC are becoming ever more difficult to find. Nonetheless, every woman should have the opportunity to carefully weigh the benefits and potential hazards of planned c-section versus planned VBAC and make the decision she feels is right for her, her baby, and her family.How does my right to "informed consent" or "informed refusal" relate to my decision about VBAC vs. repeat c-section?Informed consent is a process to help you decide what will and will not be done to you and your body. In the case of maternity care, informed consent also gives you authority to decide about care that affects your baby. The purpose of informed consent is to respect your right to self-determination. It empowers you with the authority to decide what options are in the best interest of you and your baby. Your rights to autonomy, to the truth (as best as it can be known at the time), and to keep yourself and your children safe and free of harm are basic human rights. As the person receiving care and mother of your baby, you are in the best position to decide what risks are important to you.Whether you wish to plan a VBAC or a repeat c-section, it is important to make this decision on the basis of complete, accurate, unbiased information. In practice, you will not always have access to your choice, as providers, hospitals and birth centers also have rights and may choose not to offer some types of care. However, others in your community or surrounding communities may offer the type of birth you want, including emotional support that addresses fears or anxieties that you may have. How can I learn more about my specific situation?It is essential that you seek information beyond what is provided here. Your caregivers are an important source of this information. If your caregiver proposes a repeat cesarean or a VBAC, ask:
Your decision affects the likelihood that you, your baby, and any future babies will experience dozens of risks. You can learn about these in Best Evidence: VBAC or Repeat C-Section and Best Evidence: C-Section. Your caregiver can help answer questions about this information. What if a cesarean is recommended for a new problem that is a not an urgent matter?In many cases, where some caregivers would recommend a cesarean, others would disagree that a cesarean is necessary. When the situation is not urgent, you have time to discuss the advantages and disadvantages of a cesarean with your caregiver. You can consult this website's separate Pregnancy Topic on Cesarean Section.What are some special scar-related situations when a planned c-section might be recommended, but research has not found any extra risk of having problems with the scar?
Are there any factors that do increase my risk of having problems with the scar?Overall, fewer than 1 in 100 women who labor after a cesarean experiences the scar giving way during labor, which generally leads to an urgent c-section. Researchers have found that some factors increase this likelihood. None of these factors raises this risk higher than 4 out of 100, and most do not raise it higher than 2 out of 100. In other words, 96 to 98 out of 100 women who have these factors will labor without any problem with the scar.In VBAC labors, loss of the baby occurs much less frequently than scar separation and urgent c-section. A recent major government report found that, on average, over 7,100 planned repeat cesareans (and their associated risks) are required to prevent the death of 1 baby as a result of problems with the scar. The following situations have been shown to increase risk for scar-related problems:
Are there any situations where the risk of the scar giving way (uterine rupture) is so high that labor should not be attempted?In some rare situations, it is thought that substantially more women 8 to 12 out of 100 or so will have the scar give way. Almost all care providers, including those who usually encourage VBAC, would strongly recommend planned cesarean in the following situations:
Does starting labor artificially (induction) affect the likelihood of uterine rupture?Agents used to soften and shorten the cervix (the opening to the uterus) may increase the likelihood that the scar will open and lead to problems in labor (some studies find a relationship, and others do not). Some researchers think these agents may soften the uterine scar as well. They belong to a family of hormone-like substances called prostaglandins. They may be put in a woman's vagina or, less commonly, given by mouth. Brand names include Cytotec, Cervidil and Prepidil. Please note: although a recent independent review concluded that evidence is unclear at this time, the manufacturer of Cytotec includes a warning on the official Food and Drug Administration (FDA) "label" that use of this product for labor induction increases risk for uterine rupture, which is higher for women with a previous cesarean (see references for Searle and for Guise, McDonagh and colleagues.).Using synthetic oxytocin (Pitocin or "Pit") by itself to try to start (induce) labor may also increase the likelihood that the scar will give way. In this case, at most 2 women in 100 experience this problem compared to the rate of less than 1 in 100 in women not being induced. Giving oxytocin early in labor to strengthen contractions (labor augmentation or stimulation) may also increase the risk of scar problems. Given the increasingly casual use of labor induction in the U.S., many women have the option of waiting for labor to begin on its own, or at least waiting to induce labor until changes in the cervix signal that it is ready to open. If your caregiver recommends induction to you, it is important to consider together the risks and benefits of waiting for labor to begin on its own, inducing labor, or scheduling a cesarean section. Are there any situations where the risk of the scar giving way (uterine rupture) is somewhat lower than average?If you have given birth vaginally in the past, your chances of having scar problems with a VBAC labors appear to be reduced.What factors increase my chances of having a vaginal birth if I prefer VBAC?If you have already had a vaginal birth (in addition to your c-section), you are more likely to reach a goal of VBAC than a woman who has not had a vaginal birth. See Tips & Tools: VBAC or Repeat C-Section for things you can do in pregnancy and during labor to increase your likelihood of having a vaginal birth this time around.Though I prefer VBAC, would it ever be wise to plan repeat c-section due to a situation with very low chances of having a vaginal birth?VBAC is associated with risks and trade-offs, so deciding whether to give birth vaginally after c-section is a choice that only you can make. It may help you to know, though, that some doctors developed a scoring system to try to identify the likelihood that a woman would end up having a vaginal birth, from 0 (least likely) to 10 (most likely). As expected, almost all women scoring 8 to 10 had vaginal births, but half the group scoring 0 to 2 still gave birth vaginally. Studies that have looked at such factors as suspected big baby, slow or stalled labor as the reason for the previous cesarean, going past the due date, more than one previous cesarean and others have found that despite these disadvantages half or more of women who planned VBAC achieved their goals.What can I do if fear of repeating another difficult labor is holding me back from considering VBAC?If you can identify what elements of your labor distressed you, you may be able to avoid repeating the problem. Here are some ideas:
What if deep fear of labor is holding me back from considering VBAC?Although many pregnant women have moments of apprehension about labor, some experience continuing deep-seated fear of labor. If you find yourself in this situation, a series of counseling or psychotherapy sessions during pregnancy may help you overcome these fears and keep your options open. If you decide to seek counseling, be sure to get help from a trained individual who has both good counseling skills and an understanding of maternity issues. With this help, about one-half of women who previously requested planned c-section change their minds. Continuous support during labor by a trained labor support companion (doula) may also be of special value in this situation. If you still have deep fears of childbirth despite counseling, cesarean birth may be your best option. Should this be your choice, Tips & Tools: VBAC or Repeat C-Section can help you have a safer and more satisfying cesarean birth.I've gotten the information, and I'm feeling torn: how can I decide?Pay attention to the feelings that arise as you consider these questions:
Most recent page update: 4/5/2006
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