A VBAC refers to a vaginal birth after a cesarean delivery (C-section). 

If you’ve previously given birth via cesarean section and get pregnant again, you have two options for delivering your baby. You can either have a scheduled C-section or attempt to deliver vaginally. This attempt is called a trial of labor after cesarean (TOLAC). A TOLAC may lead to a vaginal delivery (VBAC) or, in some cases, a C-section. 

While VBACs are a safe option for many people, not everyone is a good candidate. Read on to learn more about VBACs, including benefits, risks, and potential complications.

Benefits

If you’ve had a C-section in the past, you may think you’ll automatically need a C-section in a later delivery. But research suggests that vaginal delivery is a safe option for many people who have previously given birth via cesarean section. 

Some of the potential benefits of a VBAC may include:

• Less recovery time after delivery
• No surgery
• Lower risk of certain C-section complications, such as bladder and bowel injuries, infection, severe bleeding, hysterectomy (removal of the uterus), blood transfusion, and problems with the placenta
• Shorter hospital stay
• Fewer medical expenses
• Decreased risk of needing a future C-section
• Increased likelihood of continued fertility 
• Fewer complications in future deliveries
• Less scarring to the skin and uterus
• Lower risk of chronic pelvic pain
• Lower risk of respiratory distress (breathing problems for baby)
• Higher rates of success with breastfeeding

Many pregnant people also experience psychological benefits from a VBAC. Some people choose a TOLAC after a prior C-section because they want to have the experience of a vaginal delivery.

Risks

The most common VBAC risk is the need for a C-section, which sometimes must be done on an emergency basis, especially if your labor stops progressing. Labor induction with intravenous (IV) medication, like Pitocin (oxytocin injection), increases the risk that you’ll need another C-section. 

VBACs are not safe for everyone. Here are a few factors that you and your medical team should take into account when discussing your level of risk during a vaginal delivery:

• Cesarean scar: The most common type of cesarean incision leaves a low transverse scar across the lower part of the uterus. People with a low vertical or high vertical C-section scar have a higher risk of complications such as uterine rupture (tear) during vaginal delivery. If you aren’t sure what type of incision scar you have, your healthcare provider can check your medical records.
• Childbirth history: People who have had more than one C-section may be able to have a VBAC safely if all of their previous scars are low transverse. However, people who have never had a vaginal delivery in the past are somewhat less likely to have a TOLAC that ends in a VBAC.
• Size and number of babies: Some people who have a large baby or are carrying twins can safely attempt a VBAC. However, having a large baby may increase your likelihood of needing another C-section. Your medical team will monitor the size of your baby (or babies) throughout your pregnancy to make sure that a TOLAC is safe.
• History of uterine rupture: A scheduled C-section may be a safer option if you’ve experienced uterine rupture or other serious medical complications in a previous delivery.

Your healthcare provider can help assess your level of risk and decide whether a TOLAC is safe for you.

Complications

In rare cases, a VBAC may lead to serious medical complications, including: 

• Uterine rupture (tearing of the uterus): This can occur if your cesarean scar bursts open during labor. If this is suspected, you will need an emergency C-section.
• Uterine infection 
• Hemorrhage (severe bleeding and blood loss)
• Blood clots

These rare complications increase the risk of maternal death and stillbirth. In some cases, you may need to get a blood transfusion or a hysterectomy (surgery to remove the uterus) for your own safety. It’s important to note that repeat C-sections also increase the risk for most of these complications.

Because of the possible risks associated with a VBAC, you may need to plan ahead. Some pregnant people report that their healthcare providers are reluctant to recommend a VBAC. Certain healthcare providers may feel that they would not be ready to provide care in the event of a serious complication. 

According to the American College of Obstetricians and Gynecologists (ACOG), it is safest to attempt a VBAC in a hospital that is equipped to deal with a potential emergency. You might need to choose a larger hospital with a medical team that is prepared to provide ongoing monitoring and perform an emergency C-section if needed. 

If you are hoping to have a VBAC, discuss your options with your healthcare provider as early in your pregnancy as possible.

Summary

A vaginal birth after cesarean delivery, or VBAC, refers to a successful vaginal delivery after someone has had a C-section during a prior pregnancy. An attempted VBAC is called a trial of labor after cesarean, or TOLAC.

Many people who have a C-section go on to have a scheduled C-section for their next delivery, but a VBAC is a safe option for many pregnant people. Some of the benefits of a VBAC include a shorter recovery time and hospital stay, as well as a lower risk of infection and blood loss.

However, some people who attempt a VBAC may still need a C-section (and sometimes an emergency C-section). People who don’t have a low transverse cesarean scar or who have a history of uterine rupture should typically not have a VBAC. 

Serious VBAC complications may include uterine rupture, severe bleeding, infection, and blood clots. These complications are very rare. Many of them are also more likely to occur after a repeat C-section.

A Word From Verywell

Many people who have had a previous C-section want to experience a vaginal delivery in a later pregnancy. If you know that you want to try a VBAC, tell your healthcare provider as soon as possible. They can help inform you about possible risks, decide whether you are a good candidate, and find a hospital that fits your needs.