Labor, Birth & Postpartum
VBAC: Vaginal Birth After Cesarean Success Rates, Risks and Who Qualifies
VBAC stands for vaginal birth after cesarean. ACOG says most people who've had one cesarean with a low-transverse (side-to-side) cut on the uterus are candidates to try labor, and about 60 to 80 percent of those who try have a vaginal birth. The main risk is uterine rupture, which is rare (about 0.5 to 0.9 percent after one low-transverse cesarean) but serious, so labor should happen in a hospital ready for emergency surgery.
People come to this question from very different places. Some had a C-section they felt good about and just want to know their options. Others had an emergency cesarean that still feels raw, and want something different this time. Both are fine starting points. Here's how to think it through.
TOLAC, VBAC, repeat cesarean: the terms
- TOLAC (trial of labor after cesarean): going into labor planning to give birth vaginally after a prior cesarean.
- VBAC: the successful result, a vaginal birth.
- Repeat cesarean: the alternative, either scheduled ahead of time or done during labor if TOLAC doesn't work out.
Am I a candidate? A checklist
You may be a good candidate if:
- You've had one or two prior cesareans with a low-transverse incision on the uterus. (Your skin scar doesn't always match the cut on your uterus; your provider needs your operative records to know.)
- You don't have other uterine scars, such as from certain fibroid surgeries
- Nothing in this pregnancy requires a cesarean, such as placenta previa
- You'll give birth somewhere that can perform an emergency cesarean
VBAC is generally not recommended if you've had:
- A classical (vertical) or T-shaped incision on the upper uterus
- A previous uterine rupture
- Extensive surgery on the uterus that entered the cavity
What shifts your odds of success?
| More likely to succeed | Less likely to succeed |
|---|---|
| You've had a vaginal birth before (especially a prior VBAC) | Your first cesarean was for labor that didn't progress |
| The reason for your first cesarean isn't present now (for example, a breech baby) | Labor needs to be induced |
| Labor starts on its own | Older age or higher body mass index |
| Your cervix is already favorable when you arrive | Pregnancy past 40 weeks or a large baby |
| Short time between pregnancies |
These factors shift the odds but don't decide for you. Online VBAC calculators exist, and newer versions removed race as a factor. Ask your provider to help interpret any estimate you find.
The trade-offs, side by side
| TOLAC that ends in VBAC | Planned repeat cesarean | |
|---|---|---|
| Recovery | Shorter, with a shorter hospital stay | Longer; major abdominal surgery (see C-section recovery) |
| Infection and blood clots | Lower risk than surgery | Surgical risks: infection, bleeding, clots, bladder or bowel injury |
| Future pregnancies | Avoids adding another scar | Each added cesarean raises the risk of placenta accreta, hysterectomy and surgical injury |
| Main risk | Uterine rupture, about 0.5 to 0.9 percent after one low-transverse cesarean | No labor, so no rupture risk from labor |
| If plans change | An unplanned cesarean during labor carries more risk of infection and complications than a planned one | Predictable date and timing |
If you're planning more children, the future-pregnancy row matters a lot. If this is your last baby, some people weigh it differently. Both choices are reasonable.
Epidurals and induction
- Epidural: yes. ACOG says epidurals are safe for TOLAC and don't hide signs of rupture. See epidurals during labor.
- Induction: possible, but it lowers the success rate somewhat. Misoprostol isn't used after a prior cesarean because it raises the risk of rupture. A balloon catheter and oxytocin may be used with careful monitoring.
What labor is like during a TOLAC
- Continuous fetal heart rate monitoring. A change in the baby's heart rate is often the first sign of trouble, so you'll be on the monitor the whole time. Ask whether wireless monitoring is available so you can move around.
- An IV line and blood work, just in case surgery is needed.
- Close attention to how labor is progressing.
- Emergency readiness. ACOG recommends TOLAC in facilities that can provide emergency cesarean care.
Finding VBAC-friendly care in New York
Not every hospital or practice offers TOLAC. Some smaller hospitals may not have obstetric and anesthesia staff immediately available around the clock. Ask any provider you're considering:
- Do you support TOLAC, and for which patients?
- Which hospital will I deliver at, and does it allow TOLAC?
- What's the hospital's VBAC rate?
Under New York's Maternity Information Law (Public Health Law section 2803-j), hospitals must give prospective maternity patients information that includes their annual rates of primary and repeat cesareans and the percentage of people with a prior cesarean who had a vaginal birth. The New York State Department of Health also publishes hospital maternity data. Hospitals that care for more high-risk patients may have higher cesarean rates, so read the numbers in context.
To find an OB/GYN, use the directory search or browse obstetricians in Brooklyn. With a complex history, like more than two prior cesareans or prior uterine surgery, ask about a maternal-fetal medicine consult.
How to prepare for a TOLAC
- Get your operative report. Ask the hospital where you had your cesarean for the records describing the uterine incision. If it was out of state or years ago, start early; records requests can take weeks.
- Talk about timing. Ask what happens if you pass your due date, and whether induction or a scheduled repeat cesarean would be offered then.
- Write a flexible birth plan. Include your wishes for a vaginal birth and for a repeat cesarean if it becomes necessary. See how to write a birth plan.
- Line up support. A partner or doula can help you cope and stay informed.
- Know when to go in. People attempting TOLAC are often asked to come in early in labor so monitoring can start. In the city, plan your ride now, especially for rush hour.
- Give yourself permission to change your mind. You can choose a repeat cesarean at any time.
When to call your provider
If you're planning a TOLAC, go to labor and delivery right away for:
- Sudden, severe belly pain, especially pain that continues between contractions or near your scar
- Vaginal bleeding heavier than spotting
- Contractions that suddenly stop after being strong
- Your baby moving less than usual
- Feeling faint or dizzy, or a racing heart
Otherwise, follow your provider's instructions about when to come in once contractions start or your water breaks. People with a prior cesarean are often asked to come in earlier than others.
Frequently asked questions
What is the success rate of VBAC?
According to ACOG, about 60 to 80 percent of people who attempt a trial of labor after cesarean (TOLAC) have a vaginal birth. Your own chance depends on factors like why you had your first cesarean and whether you've had a vaginal birth before.
What is the risk of uterine rupture with VBAC?
ACOG estimates the risk at about 0.5 to 0.9 percent for people with one prior cesarean and a low-transverse uterine incision. It's rare but serious, which is why labor after cesarean should happen where emergency surgery is available.
Can I have a VBAC after two C-sections?
ACOG says people with two previous low-transverse cesareans may be considered for a trial of labor. Talk through your individual risks with your provider.
Can labor be induced for a VBAC?
Induction is an option for some people attempting VBAC, but it may lower the chance of success, and some methods, such as misoprostol, aren't used because they raise the risk of uterine rupture.
Sources
- ACOG — Vaginal Birth After Cesarean Delivery (Practice Bulletin 205)
- ACOG — Vaginal Birth After Cesarean Delivery: Deciding on a Trial of Labor After Cesarean Delivery (Patient FAQ)
- ACOG — Levels of Maternal Care (Obstetric Care Consensus 9)
- New York State Department of Health — Hospital Maternity-Related Procedures and Practices
This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.