VBA2C: The Facts & Statistics on Birth After 2 Cesareans

We receive a lot of questions about VBA2C, like this email from a follower:

“I am contemplating having one more child [after two C-sections]. I have moved to Utah, where I know I can easily find a doula or birthing center that would support a VBAC. After 2 though, I don’t really know all the risks. I have friends that say don’t try it, it’s too dangerous. I’m not pregnant yet. I just want to have some dialogue about it. I want to know what’s possible.”

This mother’s story is one of frustration and struggle. VBA2C and VBAMC can be a confusing and a very misunderstood topic, leaving parents with a lot of questions and doubt. I can personally say that I had a lot of those questions and doubt when I was going for my VBA2C.

What are the risks and how can you find a VBAC-friendly provider to support you? How long should you wait to get pregnant after a C-section? What are the benefits of a natural birth, as opposed to a third Cesarean?

What are the FACTS about VBA2C?

This article will answer your questions, providing facts and VBA2C statistics to help you make informed decisions with your provider about your next birth.

What is a VBA2C?

VBA2C stands for Vaginal Birth After Two Cesareans. If you have given birth via C-Section twice, your provider will consider your next birth a Vaginal Birth after 2 C-sections, even if you’ve also had previous vaginal births.

What are the risks of having a natural birth after 2 C-Sections?

Uterine rupture is the main risk discussed by healthcare providers with parents who want to have a vaginal birth after two C-sections. Uterine rupture occurs when there is a small or large tear in the uterine wall, usually at the initial Cesarean scar location. 

Although the chances are very low, there is a slight increase in rates of uterine rupture for VBA2C, with a rate of approximately 1.4%. ACOG suggests that VBA2C is still a very reasonable option and not a contraindication. 

When it comes to VBAC, there are risks that people should be aware of. However, there are also risks that come with a repeat C-Section. It is very important to learn the risks of VBA2C and repeat Cesarean before deciding on your birth plan.

What is the VBA2C success rate?

Many providers discourage their patients from trying for a VBA2C, when in fact, the chances of having a successful vaginal birth after two C-sections is pretty high. Research shows that people who decide to have a VBA2C will have a 71.1% success rate. 

One of the biggest hurdles for people who want to go forward with delivering vaginally after two C-sections is that it can be hard to find a provider who is up to date with the VBA2C facts and statistics and will truly support them. 

5 VBA2C facts you should know

Now that we’ve covered some of the most common questions about VBA2C, here are five more facts about VBA2C to help guide your journey!

P.S. Did you know, my business partner, Meagan, had a VBA2C? You can read her story here.

Look at this picture of Meagan and her VBA2C baby, aren’t they just gorgeous?!

1. Your chances of a successful VBA2C are similar to those of VBAC after just one Cesarean.

In ACOG Practice Bulletin 184, two large studies are referenced. These studies had sample sizes large enough to account for small variances that might influence the results.

It is significant for ACOG (American College of Obstetrics and Gynecology) to recognize studies like this as credible. In other words, the fact that they are even cited there is AWESOME! 

The two studies referenced in the bulletin concluded that the success rate of vaginal birth after one Cesarean and two Cesareans varies by 2% or less, depending on which study you look at. They also state that having a midwife, doula support, and going into spontaneous labor increase the likelihood of a vaginal birth.

2. ACOG recommends VBA2C as a safe option.

Speaking of ACOG, since 2010, their stance on VBA2C is that it is reasonable to consider:

“…reasonable to consider women with two previous low-transverse cesarean deliveries to be candidates for TOLAC and to counsel them based on the combination of other factors that affect their probability of achieving a successful VBAC.”

ACOG Practice Bulletin Number 205

More important to note is that there is no mention of a requirement to have had a prior vaginal delivery to be considered. If you are going for VBA2C, this bulletin is very important to have in your back pocket as you work with your provider to determine your care. ​​

3. Choosing a repeat Cesarean does NOT eliminate your chance of rupture.

We often only talk about uterine rupture during TOLAC (Trial of Labor After Cesarean, which simply means attempting VBAC), and by choosing elective repeat Cesarean, you can eliminate any chance of uterine rupture.

Although focus is usually on uterine rupture during labor, it is possible for uterine ruptures to occur before labor begins. These types of uterine rupture are usually more devastating, and can cause serious health complications or worse in mother and baby.

It is NOT true that deciding against a VBAC means that you won’t have any risk of uterine rupture. In fact, occasional studies have even found a higher rate of rupture in the elective repeat Cesarean groups! So keep in mind that it is the PREVIOUS CESAREAN that puts you at risk for uterine rupture.

4. There are things you can do to minimize uterine rupture risks.

There are many things you can do to help minimize the risk of uterine rupture, while encouraging labor to progress at your body’s pace. While induction and stimulation of labor are sometimes necessary, studies show they may be factors in uterine rupture risk.

Learning about these factors and discussing them with your provider before the birth will improve your chances of having a successful VBAC, too.

• Stay away from induction for VBAC unless absolutely necessary.
• Avoid augmentation of labor (using something to stimulate contractions, usually Pitocin)
• Avoid excessive Pitocin, and increasing the dose too fast.
• Avoid Cytotec (misoprostol) COMPLETELY.
• Avoid providers who aggressively intervene with and manage labor.
• Stay mobile. Walk, change position and posture when in active labor.
• In early labor and if labor stalls, rest or sleep.
• Do EVERYTHING you can to encourage an optimal fetal position BEFORE labor begins.
• IF your baby is not in a great position and labor stalls, or you have back labor, try optimal fetal positioning exercises like Spinning Babies, MILES circuit, abdominal lifting, side lying, or getting on your hands and knees to try and help baby settle into a better position.
• Avoid rupturing membranes if the baby is not in optimal position if possible.
• Avoid or delay getting an epidural for VBAC if possible.
• Have attentive labor support from a VBAC doula or labor coach ALL THE TIME
• Be aware of typical labor patterns. Any stall in labor is usually indicative that something needs to change (mindfulness or relaxation for birth, baby position, rest/sleep, and even Pitocin in some instances). Figure out what needs to change and fix it if you can. A long stall combined with high doses of Pitocin is a prime scenario for uterine rupture.
• HONOR YOUR INTUITION!!! If you feel that something is not quite right or if the baby’s movement is significantly decreased, insist that your provider or their staff pay attention to you. In many instances, uterine rupture occurs when a mother knows something is wrong intuitively before providers pay sufficient attention.

5. The risk for rupture is still incredibly low, maybe even the same as VBAC.

The limit of most VBA2+C research is that almost no studies have controls for Pitocin or other pharmaceutical interventions, and this may be a significant factor.

Although there is still some debate, uterine rupture rates may be somewhat higher in VBA2C when Pitocin or multiple induction agents are used. Nearly all VBA2C studies analyzed stated Pitocin or other drugs to stimulate labor were used with 50% or more of participants.

So, it is impossible to know for sure the true rate of rupture in VBA2C.

Although hard data is lacking, it seems likely that the average VBA2C rupture rate of 1.4% found in the ACOG bulletin could be reduced by inducing less, inducing only when the cervix is ripe, when induction is truly necessary, and using drugs and interventions a lot less (and much more judiciously when they are used).

So, with all this information, should I attempt (TOLAC) a VBA2C?

This is a decision that each family must make for themselves. Take a look at your desires and fears and what motivates YOU. Weigh the benefits and risks based on your specific needs and circumstances.

Listen to the advice of your providers, but remember that each provider differs, sometimes drastically, in their support, knowledge, and how they approach VBA2C. They may not be up to date with current recommendations and guidelines.

Moving forward, seek out the current recommendations and research, talk to several providers and get their opinions until you find one whose knowledge and philosophy align with yours. Weigh the potential risks and benefits and check your own intuition to decide what is best for YOU and YOUR family.

Where to find even more info about VBA2C

Learn more about not only VBA2C but Vaginal Birth after Multiple C-sections (VBAMC) on our blog. 

Check out Episode 2 of our podcast, all about Meagan’s VBA2C journey. Then find more VBA2C birth stories as you continue to listen.

Want to learn everything you can before your VBAC? Register today for our Ultimate VBAC Course for Parents.