For many women who have given birth via cesarean section (C-section) in the past but want to consider a vaginal birth moving forward, the VBAC approach (vaginal birth after cesarean section) is the top option out there. Its success rates are quite high for those who have had C-sections before, and most women who have had past C-sections will be candidates for it — how can you tell if you’re among them? 

At The VBAC Link, we’re proud to offer a huge range of resources and assistance for VBAC birth, plus in areas like doula training and certification to assist people with these exact needs. We happily work with many clients to help them determine whether they’re a good candidate for a VBAC birth, plus how to increase the chances of a successful VBAC birth. How can you tell if you’re a good candidate for this approach, what are a few rare signs that you might not be, and what else do you need to know here? Let’s run through an important primer.

VBAC Benefits + Possible Risks

The VBAC process is one that carries significant benefits — but just like any other medical procedure, it may also have certain risks for some people. The main benefit is simple, and is actually a form of risk reduction itself: By going the VBAC route, expecting mothers help limit some of the risks that come with repeat C-section births. These risks include infection, uterine rupture (a very serious complication), hemorrhage, and more.

Additionally, VBAC births are often shorter in duration than C-section births, and involve less blood loss on the part of the mother. They also tend to come with a shorter hospital stay for both mother and child, carry lower risks for certain types of chronic pain later in life, and may even improve breastfeeding success rates.

When having a VBAC there are certain risks that must be considered. These include the risk of uterine rupture (although this is very rare), as well as the possibility of an unsuccessful VBAC attempt that still results in a C-section being necessary. In either case, an expectant mother should be sure to have a detailed discussion with her care team about any and all risks that may be associated with a VBAC birth.

Trying for a VBAC? You Might Be a Good Candidate If…

There are certain factors that may make a woman a good candidate for VBAC. These include all of the following, and possibly some others:

• Previous successful vaginal delivery: If you’ve already had a prior vaginal delivery that was successful, including if this was a VBAC delivery, you’re more likely to be a good candidate for another VBAC.
• C-section due to failure to progress: If your C-section was due to issues like fetal distress or failure to progress, as opposed to complications with the baby’s positioning or size, you have a better chance of having a successful VBAC.
• Age ranges: Generally speaking, research has shown that women under 35 years old have more successful VBAC births with fewer complications.
• Incision: Those who had a low-transverse (horizontal) incision during their C-section are more likely to have a successful VBAC than those with a vertical or T-shaped incision.
• Number of C-sections: Women who have had 1-2 prior C-section are more likely to have a successful VBAC than those who’ve had 3 or more.
• Time since your last C-section: The further out from your last C-section you are, the more likely you may be to have a successful VBAC.
• Weight: Research has shown that women who are overweight or obese may still have a successful VBAC, although this is an area where more research is needed.

Situations Where VBAC May Not be Recommended

On the flip side, safety of the mother and child are of paramount importance, and they may dictate that VBAC is not recommended in certain cases:

• Vertical incision: Many physicians will not attempt a VBAC if the mother’s prior C-section incision was vertical or T-shaped. Although it is still possible such as in episode 168 on our podcast.
• Multiple C-sections: Women who have had multiple C-sections may be less likely to have a successful VBAC, although this is an area where more research is needed.
• Labor dystocia: If the mother has a history of labor dystocia (difficult or prolonged labor), VBAC may not be recommended by a provider, but many people will still opt for a VBAC:  https://www.thevbaclink.com/failure-to-progress/ 
• Placenta previa: If the mother has placenta previa (a condition in which the placenta covers the cervix), VBAC may not be recommended.
• Health complications or past due date: If a mother has health complications a VBAC may not be suggested if it is not safe for the mother or the baby. Going past your due date is a very common thing but once that due date creeps up many providers do not suggest having a VBAC if you are over your due date. Learn more about going past 40 weeks and VBAC on our blog https://www.thevbaclink.com/vbac-after-40-weeks/
• Especially large baby: If your baby has been diagnosed to be large, a provider may discourage any VBAC attempt. A large baby is considered more than 10 pounds leading up to the delivery. If you have been told your baby is large learn more about how you can have a VBAC with a larger baby. https://www.thevbaclink.com/get-that-big-baby-out/

As we noted above, it’s vital to speak with your care team about any and all risks that may be associated with a VBAC birth before making a final decision.

Increasing Likelihood of a Successful VBAC

While you can’t control every element that may dictate a successful VBAC, here are some areas that may help your chances:

• Weight management: As we noted above, being overweight or obese may decrease the chances of a successful VBAC. For this reason, working to maintain a healthy weight both before and during pregnancy may improve your chances.
• Early conversation with doctor: If you’re interested in VBAC as an option, be sure to bring it up with your doctor or care team as early as possible. This will give you ample time to discuss risks and create a plan that’s right for you.
• Natural labor, no induction: Studies have shown that labor induction may decrease the chances of a successful VBAC. If possible, aim for a natural labor with no intervention.
• Having a supportive care team: Finally, one of the most important things you can do is to make sure you’re surrounded by a care team (including your doctor, midwife, and nurses) that supports your decision to attempt a VBAC. If you don’t feel supported, it may be worth considering another care team or provider.

The most important thing to remember is that VBAC is a very individualized decision, and there’s no right or wrong answer. The best way to make a decision is to arm yourself with as much knowledge as possible, then work with your care team to make the best decision for you and your baby.

For more on this, or to learn about any of our VBAC services, doulas or other programs, speak to the team at The VBAC Link today.