Vaginal Birth After Cesarean

Women who have had a prior Cesarean birth have the option of having a repeat Cesarean or a vaginal birth after Cesarean (VBAC) in this pregnancy. You can learn more about these two options by watching the following video or reading the summary below. As always, be sure discuss your options with your health care team. 

The material provided in this video (including text, graphics, images and information) is intended for education and information purposes only. It is intended to aid you in making informed decisions in consultation with your physician and health care team. It is not intended to diagnose or replace the need to see a physician or other health care provider. This video reflects the policies, procedures and values and is the sole property of The Ottawa Hospital. www.ottawahospital.on.ca

Repeat Cesarean

• If you choose to have a repeat Cesarean section, an Obstetrician will deliver your baby though the same incision from your previous Cesarean birth
• Benefits include: avoiding risks associated with labor and VBAC, avoiding the risk of an emergency Cesarean birth and planning in advance the date of surgery 
• Surgical risks include: fever and infection, bleeding which can require a blood transfusion, damage to other organs and complications with anesthetic 
• In future pregnancies you will likely need a Cesarean and there may be a higher risk of placental problems due to the Cesarean scar 
• Risks for baby include: short term breathing problems and potential admission into the special care nursery/ neonatal intensive care unit, this happens in 4.5 of 100 (4.5%) Cesarean births 

Vaginal Birth After Cesarean (VBAC)

• A VBAC should not be tried if: you have a classical or inverted T scar from your previous Cesarean birth, previous uterine rupture or surgery, or if you have any other contraindications for labor 
• Attempted VBACs are successful 50-85% of the time
  • Factors associated with increased success include: spontaneous labor before 41 weeks, normal labor progression and previous vaginal birth 
• Benefits include: easier and shorter recovery, less risks related to surgery, less breathing problems for baby and increased likelihood of future vaginal births 
• VBAC risks include: 25-50% chance of needing an emergency Cesarean, vaginal/perineal tears, infection and excessive bleeding 
• There is a higher risk of uterine rupture with VBACs (5 in 1000 VBACS; 0.5%) which requires an emergency Cesarean 
  • Factors that increase risk of uterine rupture include: more than 1 previous Cesarean, use of drugs to augment labor and less than 18 months between births  
• In a VBAC the risks to baby are related to the risk of uterine rupture 
  • Risk of serious injury or death happens in 4-8 in 10,000 babies (0.04-0.08%)

It is important to remember things don’t always go as planned and to be prepared for the fact that some women who plan a repeat Cesarean will go into labor before surgery 

• Some women who attempt a VBAC will require an emergency Cesarean

Regardless of choice, both options have risks 

• In general VBAC has the least amount of risk for you and baby 
• A repeat Cesarean has more surgical risks to you 
• An unsuccessful planned VBAC requiring an emergency Cesarean has the most risk