Research makes it clear that both VBAC and repeat C-section have potential benefits and harms. As you learn about these risks and benefits, you’ll make a decision based on your values, needs and circumstances. Factors like the amount of postpartum support you will have, your plans for future children, your feelings about your first birth experience and many other things will probably be part of that decision. Ultimately, every woman should have the opportunity to review the data and make the decision she feels is right for her, her baby and her family. On this page, we provide additional suggestions and considerations to help you arrive at the right decision for you.
We also strongly encourage you to read the Cesarean Section (C-Section) part of this website, which includes information on how you can maximize your satisfaction with your birth when having a C-section.
How can I learn more about my specific situation?
Your care provider can provide information about your unique needs and the risks and benefits to you and your baby. He or she may recommend VBAC over repeat C-section or vice versa.
In many cases, one care provider might recommend a C-section while another does not. When the situation is not urgent and you don't have to make an immediate decision, you have time to discuss your options and seek a second opinion if necessary.
When you set out to make this decision, consider asking your care provider:
- What will be involved in laboring after cesarean/having a repeat C-section?
- Is there anything about my specific situation/pregnancy that I need to consider?
- What are the possible benefits of following your recommendation?
- What are the possible risks of following your recommendation?
- What are the pros and cons of the option you are not recommending?
Your decision affects the likelihood of dozens of different risks that you, your baby and any future babies will experience, as summarized on our Research and Evidence page.
Beware of tools that predict your likelihood of giving birth vaginally, should you decide to plan a VBAC. Various tools for prediction have been developed. These are good at predicting women will have a vaginal birth but poor at identifying women who will have a cesarean after laboring.Eden, K.B., McDonagh, M., Denman, M.A., Marshall, N., Emeis, C., Fu, R., Janik, R., Walker, R., & Guise, J.M. (2010). New insights on vaginal birth after cesarean: can it be predicted? Obstetrics and Gynecology, 116(4), 967-81.
I'd like to plan a VBAC. How can I increase my chances of having one?
If you have already had a vaginal birth (in addition to your C-section) and plan VBAC, you are more likely to give birth vaginally than a woman who has not had a vaginal birth. Your chance of having a vaginal birth also depends on choices you make during pregnancy and how you are cared for in labor. Here are some tips for ways to increase your chances:
- Choose a doctor or midwife who favors VBAC: Unfortunately, with changing cultural views of C-section and VBAC, it could be hard to find a provider who offers VBAC, especially in some community hospitals and rural areas. Discuss your goals and preferences with potential care providers and find out how they will work with you to meet your objectives. If their response does not satisfy you and you have other options, seek a better match.
- Hire a doula (trained labor support specialist): The continuous presence of a trained, experienced woman can help you deal with anxiety about VBAC. She will know ways to help you relax, ease pain and promote progress. Read more here.
- Stay in touch with a nurse or care provider by phone to help you delay hospital admission until you are in "active" labor (you are having regular, strong contractions and your cervix is open about 6 centimeters - out of about 10 total): Women who are admitted to the hospital before their uterine contractions are well-established are less likely to have VBAC.
- Avoid labor induction when possible: The risk for C-section increases when providers use drugs or other techniques to start labor.
- Commit yourself to vaginal birth: If you ask for a C-section in a weak moment, your request is likely to be granted.
- If a C-section is proposed and you're not in an emergency situation: Ask why it's being recommended; the benefits and risks of surgery; other possible solutions to the problem, including just waiting longer; and the benefits and risks of those options. If you aren't in labor at the time the issue arises, you should have time to do your own research and talk things over with your partner and care providers before making a decision.
- If your baby is in a buttocks- or feet-first position (breech): Very few care providers will agree to vaginal birth with a breech baby. Ask your doctor if he or she can turn the baby to a head-first position with hands-to-belly movements (external version). This may be an option if your baby is breech and you have reached "term" (about the 37th week of pregnancy). You may need to search to find a provider who has skills and experience with this technique. There is not much research on external version in women with prior C-sections, but existing research does not indicate extra problems.
What if I can't find a hospital and care provider who will support my wish for VBAC?
The VBAC Resources page provides links for locating providers and facilities that offer VBAC. If you feel strongly about having a VBAC and can't find someone to provide this service close to your home, you may wish to consider driving farther to access supportive care or even moving temporarily (consider staying with a friend or relative) to a place where you can get a VBAC.
You may be able to find a provider who is willing to try VBAC outside of the hospital, at home or in a birth center. Keep in mind that while many birth centers and home birth practitioners have had good success with helping women who plan VBAC achieve vaginal birth, a national study of VBAC in birth centers found that because it has risks, VBAC should be performed in a hospital setting.
My first labor was difficult and now I'm afraid of going through that again. What should I do?
Identifying what factors made your earlier labor so hard may help you avoid those problems this time. Here are some ideas:
- If you feel that you didn't have supportive care from your care providers, you may wish to choose a different care provider, birth setting, or both. The Choosing a Care Provider and Choosing a Place of Birth pages can help.
- If you feel that you didn't get the support you needed from your spouse/partner or other people in the room, consider hiring a doula (trained labor support companion) or invite a friend or relative to assist you and your partner. The Labor Support section has more information about doulas and resources for finding one.
- If you were frustrated by long, non-productive hours in labor or pushing, you can:
- Get peace of mind knowing that your next labor may proceed very differently; the first is usually the longest.
- Learn what can interfere with labor progress and how to help labor progress more smoothly; a doula can really help here.
- Decide ahead of time on reasonable limits for the cervix to dilate fully and then for you to push the baby out. Knowing you have an end point can help you feel less anxious and more in control. If you reach this point, you can choose whether to go beyond it. Keep in mind that women with prior C-sections tend to labor more like first-time mothers than women who have given birth vaginally.
- Be patient. How long labor lasts is different for each birth and each woman. With good support, encouragement and the full range of comfort and pain relief options, you can cope with longer labor.
- If you had a lot of pain, become informed about epidurals, which tend to offer effective pain relief, and consider planning to have one. A doula can also help with comfort measures and helping you stay calm and relaxed in labor.
What if I have unresolved emotional issues?
If you had an extremely difficult or frightening birth experience before, or have been through other traumatic experiences like sexual abuse, thinking about labor may bring on very strong emotions. You might feel like you cannot deal with making any decision. These unresolved issues can make your labor more difficult, too. So what can you do? Here are a few tips:
- Get professional counseling from a mental health professional who is well-informed about maternity issues.
- Keep a journal.
- Talk through the troubling events and your concerns with a friend or relative.
- Seek peer support from other women who have had similar experiences. You can find peer support resources here.
If you have an extreme fear of childbirth, counseling or therapy may help you overcome these deep fears and give birth vaginally. Continuous support during labor by a trained labor support companion (doula) may be especially helpful in this case. If you still have deep fears of childbirth despite counseling, you may decide to have a C-section. Be sure to talk this over with your care provider as early as possible in your pregnancy, and work together to help ensure the safest possible and most satisfying birth.
If I plan a VBAC, how can I avoid problems with the scar?
- Wait at least 9 months before trying to conceive again. Research suggests that you are less likely to have a problem with the scar rupturing in labor if there is at least 18 months between births.
- Avoid induction of labor whenever possible. The medications used during labor induction may increase the risk of scar rupture and do increase the likelihood that the labor will end with a C-section for some groups of women. Therefore, it's best to avoid induction unless it's medically necessary. Read more in the Induction section.
- If your labor is being induced, avoid cervical ripening agents. These can also weaken the scar, increasing the risk of rupture. Read more about the role of cervical ripening agents and rupture here.
- Avoid use of synthetic oxytocin (Pitocin or "Pit") early in labor. Once labor is well underway, Pitocin doesn't seem to cause a problem, possibly because more forceful contractions over a longer period of time are needed to get labor going than to help it along once it is in progress.
Are there practices or procedures used in VBAC that I should try to avoid?
You should try to avoid the following practices because no research shows they are beneficial and, in fact, they can reduce the chance of vaginal birth, increase the risk of harm and/or increase discomfort.
- Internal monitoring of contraction pressures (not the same as internal monitoring of the baby's heart rate). Some people believe that if the scar ruptures, internal contraction monitoring will alert your provider to this fact because the contraction pressure will drop, but studies have not supported this. Internal monitoring increases the risk of uterine infection and limits movement during labor.
- Banning women from eating and drinking during labor. Some providers are concerned that if the woman ends up needing general anesthesia for a last-minute C-section, she could get an infection by vomiting and inhaling the vomit into her lungs. However, C-sections rarely require general anesthesia and when it is used, a tube is inserted to make sure the woman can breathe. If hospital staff won't allow solid food, ask for frequent sips of clear fluids, which are rapidly absorbed into the bloodstream.
- Routine intravenous (IV) drip. If the hospital requires an IV line, ask for a heparin or saline lock. In this case, the IV needle is inserted with a short piece of tubing attached and heparin or saline keep the needle from clogging. In an emergency, an IV bag can be connected immediately.
- Routine internal examination of the uterine scar after vaginal birth. This is extremely painful for a woman who doesn't have an epidural; it could introduce infection; and it could turn a small, harmless gap in the scar into a problem.
If your care provider recommends any of these practices, you may want to discuss the specific risks and benefits to you and your baby before deciding.
If I plan a repeat C-section, how can I make it as safe as possible?
- Schedule the C-section after the 39th week of pregnancy if there is no urgent reason to give birth sooner: Babies born before the 39th week of pregnancy are more likely to have breathing and other problems.
- Use epidural or spinal anesthesia. Regional anesthesia (you are numbed from your ribs down) is safer for you and your baby than general anesthesia (being "put to sleep").
- Request antibiotics before the C-section incision. Antibiotics reduce the chance of infection. You do not need them afterwards unless you develop an infection.
- Request care after the surgery to reduce the chance of blood clots. Depending on how likely you are to have this problem, you may need to get up and walk soon after the operation, wear elastic support stockings or mechanical leg compression devices, or take medication to prevent blood clots.
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:
- If you decided on VBAC and it ended with another C-section, would you feel better for having tried or worse because you went through labor only to have another C-section?
- If you scheduled a C-section, would you feel relieved not to have to go through labor again or upset because you wouldn't know what would have happened if you had chosen VBAC?
- If you planned a VBAC and had one, what would that mean to you?
A care provider who supports VBAC…
…believes women should labor unless there is a new reason for C-section or a compelling reason not to labor. Even in these cases, the caregiver respects a woman's right to make the final decision.
…doesn’t create unnecessary barriers by refusing VBAC for women expecting big babies, women with gestational diabetes, or when the pregnancy goes past 40 weeks.
…provides care that results in vaginal birth for at least 70 percent of the women who plan VBAC (not of all women with a past cesarean). Dozens of studies involving tens of thousands of women have shown that a rate of 70 percent or higher is an achievable goal.