Vaginal Birth After Cesarean Section (VBAC)

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Can I have a vaginal birth after a C-Section?

VBAC or TOLAC (Trial of Labour After Cesarean Section) are both terms used to describe a client who has previously had a c-section and is now attempting to give birth vaginally. For any client who has previously had a c-section, the choice between TOLAC and elective repeat c-section (ERCS) is a very personal decision. Many factors come into play when deciding to try for a vaginal birth or have an ERCS. One of the primary concerns for clients is usually:

Will it work, can I have my baby vaginally? While midwives can never say for certain if a client will deliver vaginally, the information below indicates if a client has higher or lower chances of a vaginal birth after c-section.

Chances of having a VBAC increase if:

  • You have had a vaginal birth before
  • The reason for your last c-section is not an issue this time (ex. Baby was breech last time)
  • You are younger than 35 years old
  • Your labour starts on its own
  • Your labour progresses typically

Chances of having a VBAC decrease if:

  • You have had more than one c-section
  • Your BMI is over 25
  • You are 35 years of age or older
  • You are given oxytocin to start or augment your labour

Overall, research shows that 75% of VBACs planned with Ontario midwives will have a successful vaginal birth, and 25% will have an emergency repeat c-section (AOM 2021).

Also important for decision-making, is to understand the risks involved for both TOLAC and ERCS.

 

Risks of VBAC

1. Uterine rupture is when the wall of the uterus splits (usually along the previous c-section scar), requiring emergency surgery. Uterine rupture occurs in approximately 0.5% of all VBACs, which is equal to 1 uterine rupture for every 200 VBACs (AOM 2021).

  • In approximately 6% of all uterine ruptures the following severe complications occur (AOM 2021):
    • for the birthing parent excessive bleeding or removal of the uterus (hysterectomy)
    • for the baby, brain damage or death can occur
  • It is important to remember that uterine rupture happens very rarely, so severe complications only happen in 6% of 0.5% of all VBACs (AOM 2021).
  • Chances of uterine rupture may be higher if:
    • You had your last c-section less than two years ago
    • You have had more than one c-section
    • You are given oxytocin to start or augment your labour

2. Having an emergency c-section: An emergency c-section happens for approximately 1 in 4 clients who plan VBAC

 

Risks of Elective Repeat C-Section

  1. Problems related to c-section surgery include fever, infection, injuries to the bowel or bladder, or blood clots. These risks would be relatively similar to your first c-section.
  2. Neonatal breathing difficulties can occur for the newborn immediately after birth. C-section babies have not been squeezed through the birth canal as in a vaginal birth. This squeezing motion helps to expel the fluid from the baby’s lungs in the final moments before birth. Midwives and hospital staff are well-trained to deal with baby breathing problems. Most of the time these issues are mild and the babies recover very quickly. If the baby goes to the NICU for monitoring, you may be separated from the baby (for how long is determined by the pediatrician). These risks would be relatively similar to your first c-section.
  3. Placenta complications in future pregnancies can occur with how the placenta attaches itself to the uterus (placenta previa and placenta accrete), leading to potentially severe bleeding in the postpartum period. The risk of placenta-related issues increases with the number of c-sections a client has.

Please see the following additional resources for more details and ask your midwife if you have any questions.

Additional Resources:

Third Stage of Labour
Induction of Labour