Vaginal Birth After Cesarean (VBAC): A Complete Guide for Expecting Mothers

Can you give birth vaginally after a C-section? Many women assume that once you have had a cesarean delivery, it must always be this way for future pregnancies. But what if we told you that many women choose to give birth vaginally, even though they have previously had cesarean babies? VBAC is a safe delivery option for many, but a lack of knowledge, fear, and confusion clouds this for some expecting parents.

This complete VBAC guide promises a balanced, evidence-based approach to help you make an informed decision about whether a VBAC delivery is right for you. VBAC childbirth is nothing to be afraid of, and many women have successful labours instead of choosing a repeat c-section delivery.

• Can you give birth vaginally after a C-section?
  
• What is VBAC?
  
• Why do some women choose VBAC instead of another c-section?
  
• Who is a good candidate for VBAC?
  
• VBAC success rate: What do the numbers say?
  
• Benefits of Vaginal Birth After Cesarean
  
• What are the risks of VBAC childbirth?
  
• VBAC vs. repeat c-section: What is the difference?
  
• How to prepare for a VBAC
  
• Emotional Considerations: It’s more than a medical decision
  
• Questions to ask your healthcare provider about VBAC
• Your birth, your informed choice
  
• VBAC Frequently Asked Questions

What Is VBAC?

VBAC stands for “Vaginal Birth After Cesarean”, which means you are giving birth to your baby vaginally after previous pregnancies where your baby was delivered by c-section. When searching the internet about VBAC delivery, you may also come across the term TOLAC, which stands for “Trial of Labour After C-section”. The two definitions should not be confused, as they differ in meaning.
VBAC means you have successfully delivered your baby vaginally after having c-section pregnancies.

TOLAC means you have tried to give birth vaginally, but it does not result in a vaginal birth. Often, labour is trialled to see whether a vaginal birth will be successful, and if not, your medical team will intervene to deliver your baby through surgery.

Why Do Some Women Choose VBAC Instead of Another C-Section?

For many mothers, choosing a Vaginal Birth After Cesarean (VBAC) isn’t just a medical decision; it’s a personal one. Delivering your baby vaginally is a completely different experience from a C-section delivery, and for some mothers, having a C-section wasn’t their first choice. 

Common reasons why women consider VBAC include:

• A desire to avoid another major abdominal surgery
  
• Hoping for a shorter hospital stay
  
• Potentially quicker physical recovery
  
• Wanting to experience labour and vaginal birth
  
• Planning for multiple future pregnancies (as repeated C-sections can increase surgical risks over time)
  

For some, VBAC also carries emotional meaning. When a previous C-section is unexpected or medically necessary in that moment, it can feel like the opportunity for vaginal childbirth is taken from you. That emotional tug encourages some mothers to attempt a vaginal birth, which can feel empowering and even healing.

That said, VBAC isn’t the right choice for everyone. Your healthcare professional will always advise the safest option based on your health and previous pregnancies.

Who Is a Good Candidate for VBAC?

Your doctor will assess whether VBAC is a safe delivery option for you before your birth plan is decided. The decision will be based on historical pregnancies, previous surgeries you have had, and your overall health. Common eligible VBAC delivery factors are:

• One previous low transverse C-section incision
  
• No history of uterine rupture or other uterine surgeries
  
• Healthy pregnancy without major complications
  
• Access to a hospital equipped for an emergency C-section
  
• Ideally, only had one c-section previously (VBAC may still be possible if you have had two c-sections)
  
• At least 18 months have passed since a c-section birth before attempting VBAC
  

The final decision really boils down to what your healthcare provider recommends for you in your circumstances. It is purely individual and assessed on a case-by-case basis.

VBAC Success Rate: What Do the Numbers Say?

According to recently published medical guidance around VBAC, up to 75% of TOLAC labours resulted in a successful VBAC delivery. If the mother had previously had a vaginal birth in earlier pregnancies, this increased to 90%. 

On average, you can expect a 60-80% VBAC success rate. This varies due to the health of the mother and her unique pregnancy. Not one pregnancy is alike! 

• You can expect an increased VBAC success rate if:
  
• Previously had a vaginal birth
  
• Labor starts naturally
  
• Healthy BMI
  
• No recurring medical issues
  

Whilst there is no guarantee of your labour resulting in a vaginal birth after cesarean, you can increase the chances of it being a success. 

Benefits of Vaginal Birth After Cesarean

C-sections can be planned or performed as an emergency procedure when complications arise during labour. The C-section recovery timeline is much longer postpartum because your body is healing from major abdominal surgery and pregnancy all at once. With a vaginal birth, your recovery time is much shorter because there is little to no surgery performed at all, which is a huge benefit to mothers' postpartum recovery.

Mums who have a VBAC delivery also benefit from a lower risk of future placental complications in future pregnancies, shorter hospital stays, lower surgical risk, and potentially the emotional satisfaction of successfully giving birth vaginally.

Mums who have c-section births also manage other elements of their recovery long-term, such as c-section overhang and c-section scar healing. In the early weeks, a postpartum support band can help mums to be more mobile and “put together” after surgery. Our “C-Section Recovery Guide” explains everything you need to know, should VBAC not happen this time around.

What are the Risks of VBAC Childbirth?

While VBAC is safe for many women, it is not without risks. The most serious, although rare, is uterine rupture. This occurs when the scar from the previous C-section opens during labour. Uterine rupture is the primary concern with VBAC. The risk is low, but it must be assessed carefully.

Most studies show that:

• Women with a low-transverse (horizontal) uterine scar have about a 0.5% to 1% risk of rupture
  
• Those with other incision types may have higher risk levels
  
• Uterine rupture is very rare but increased with VBAC: about 1 per 10,000 if a woman has a repeat cesarean birth and 5 per 1000 (1 in 200) VBAC.
  

Although the uterine rupture may be small, it is treated seriously, and constant monitoring is crucial during VBAC childbirth. Your medical team will ensure that a cesarean surgery is available if needed for emergency delivery as well as blood transfusions. 

Other risks to be aware of for VBAC delivery are:

• Failed trial of labour that results in an emergency C-section
  
• Infection
  
• Heavy bleeding (resulting in blood transfusion)
  
• Potential complications for the baby if labour does not progress safely
  

These risks are why VBAC should only be attempted in a fully equipped hospital with experienced obstetricians and an emergency surgical team available at all times. Throughout the VBAC delivery, you will be closely monitored, which will significantly reduce the risk of further complications in labour.

VBAC vs Repeat C-Section: What’s the Difference?

If you’re still weighing up your options, a visual comparison can help to simplify the information. With a big decision like this, sharing it with you and your partner only helps you to support each other through the process. 

If you are pregnant with multiple babies (twins, triplets, etc.) VBAC is still an option. Your healthcare professional will advise based on your pregnancy history and your general health. In this article, published by the International Journal of Gynaecology and Obstetrics, they talk about there being very few differences in outcomes when comparing successful VBAC with repeat c-section birth.

NHS England shares some useful statistics and points which could help you decide which delivery option is the right one for you. They say that if you are fit and healthy, both VBAC and elective repeat c-section (ERCS) are “safe choices with very small risks”.

How to Prepare for a VBAC

The earlier you can prepare for VBAC and inform your healthcare provider, the better. You can discuss your birth plan with your midwife early on and confirm whether VBAC would be the safest choice for this pregnancy. They may want to review the surgical notes from prior c-section births to iron out any complications.

As with any pregnancy, staying active and eating well will benefit you in the long run. Read more about pregnancy nutrition, the recommended diet, and pregnancy cravings on the Lola&Lykke blog.

Other practical tips and advice to follow if you’re considering VBAC are:

• Maintain a healthy pregnancy weight
  
• Postpartum care for Mum (e.g. self-care gifts)
  
• Pelvic floor strengthening
  
• Perineal massage (shown to reduce vaginal tearing)
  
• Educate yourself about labour positions
  

Emotional Considerations: It’s More Than a Medical Decision

VBAC is more than a medical term for some mums. It’s an opportunity to have the labour they envisioned, which brings feelings of fulfilment and empowerment. On the flip side, other expecting mums like the predictability of a repeat cesarean and already understand what their C-section recovery will look like with a newborn.

Sometimes, vaginal birth is referred to as “natural”, but in reality, the most natural thing is childbirth, regardless of what it looks like. You are not “too posh to push” for choosing a repeat C-section, and you are not to feel ashamed for wanting to experience a vaginal birth.

Both of these choices are valid and completely personal. The trust between you and your healthcare professionals ensures your wishes are heard and fulfilled with you and your baby’s safety as the priority.

What Happens If VBAC Doesn’t Go as Planned?

You will not be the first, and certainly not the last, woman whose ideal birth plan didn’t go the way they had imagined. It’s good to have an idea of how you want the birth to go, but consider it as a first draft rather than a final plan.

Many women attempt TOLAC and then need a c-section birth, and that’s ok. There’s no failure or shame to be worn in the delivery room; keeping you safe is the priority. Your medical team’s main focus is to have a happy, healthy, and safe childbirth for both the mother and her baby.

Questions to Ask Your Healthcare Provider About VBAC?

Keeping the conversation open and honest with your healthcare provider is essential when deciding between VBAC and a repeat C-section. If you’re not sure what to ask, use these questions to help steer the conversation and get the clarity you need to make an informed decision.

• Am I a good candidate for VBAC based on my medical history?
  
• What type of incision was used in my previous C-section?
  
• What are the realistic chances of a successful VBAC in my situation?
  
• How will labour be monitored to reduce the risk of uterine rupture?
  
• What signs would indicate that labour isn’t progressing safely?
  
• Is the hospital equipped for an emergency C-section if needed?
  
• What are the benefits and risks of choosing a planned repeat C-section instead?
  
• How does this pregnancy (baby size, spacing, health conditions) affect the recommendation?
  

You’re not using these questions to convince anybody of your decision. You’re asking so you can feel prepared and confident in your decision. The goal isn’t a “perfect” birth plan. It’s a safe and supported one.

Final Word: Your Birth, Your Informed Choice

Now that you’re more clued up on VBAC childbirth, consult your healthcare provider and partner about the different options available to you. Making an educated decision eliminates choosing out of fear, and gives your partner the means to advocate for you if you can’t. VBAC is possible for many women; they just don’t know it yet!

If you’re already thinking ahead to postpartum, you’ll know you will need gentle recovery support. A postpartum support band can help you heal confidently, whether you have a vaginal birth after cesarean or a repeat c-section. 

VBAC Frequently Asked Questions

 1. Does the Type of Incision From My Last C-section Matter for VBAC?

Yes, the type of incision is one of the most important factors in determining VBAC eligibility. There are three types of C-section incisions:

• Low-transverse incision (horizontal): This is the most common type and has the lowest risk of rupture. Most women with this incision are good candidates for VBAC.
  
• Low-vertical incision: This incision is less common and comes with a moderate risk. Some women with this incision may still be considered for VBAC after evaluation.
  
• Classical (vertical upper uterine) incision: This carries the highest risk of rupture, which is why women with this incision are usually advised to choose a repeat C-section.
  

Your doctor will review your previous surgical records to understand your incision type and overall surgical details before recommending VBAC as a viable option or not.

2. Is a VBAC Safer Than a Repeat C-section?

The safety comparison depends on your individual case. Your doctor will guide you based on your health profile and your baby’s well-being. For many eligible women:

• VBAC is safer than undergoing another C-section because it avoids surgical risks.
  
• A successful VBAC is generally considered the lower-risk option.
  

However:

• If VBAC fails and an emergency C-section becomes necessary, the risks may increase.
  
• Some women with specific medical conditions, pregnancy complications, or certain uterine scars may have better outcomes with a planned repeat C-section.
  

3. What Are the Risks of Multiple C-sections?

Each c-section increases certain risks in future pregnancies. These include:

• Placenta accreta: This is a serious condition where the placenta attaches too deeply into the uterine wall. It becomes more likely with every C-section.
  
• Placenta previa: The placenta covers part or all of the cervix, increasing the risk of bleeding.
  
• Surgical complications: Repeated surgeries may lead to adhesions, longer operating time, higher blood loss, and increased scarring.
  
• Increased recovery time: Extra scar tissue can make future procedures more complicated and slow down recovery.
  

Because of these cumulative risks, women planning larger families may prefer VBAC when medically appropriate.

4. Is VBAC safe for most women?

VBAC is safe for many women who meet the medical criteria. Your eligibility depends on your health, the type of previous C-section incision, and how your pregnancy is progressing.

5. Can I choose a VBAC if I had two previous C-sections?

Some women with two previous low-transverse incisions may be eligible, but the decision requires a detailed evaluation by your obstetrician.

6. Will I need pain relief during a VBAC?

Pain management options are similar to vaginal births. Your doctor may recommend an epidural anaesthesia if needed.

7. What can increase the chances of a successful VBAC?

Healthy weight gain, proper prenatal care, regular monitoring, and going into labour naturally often improve the chances of success.

8. Can induction be done during a VBAC?

Induction is possible but should be used cautiously because some induction methods may increase the risk of uterine rupture. Your doctor will choose the safest option.

9. How long should I wait between pregnancies for a VBAC?

Many doctors recommend an interval of at least 18 to 24 months after a C-section before attempting VBAC. This reduces the risk of complications.

10. Does VBAC hurt more than a C-section?

Whether it hurts more or less is down to the individual. However, it’s not a case of measuring which delivery method will hurt more because the two are completely different. VBAC means you’re experiencing labour as it progresses, and a c-section is surgical.