Is VBAC after 3 C-Sections Safe (and Right for You)?

Wondering if it’s possible and safe to have a vaginal birth after 3 C-sections?

VBAC after 3 C-sections is possible, and studies show very little increased risk of serious complications compared to vaginal birth after one or two C-sections. While everyone is different and will have different circumstances, overall VBAC success rates range from 60% – 80%.

However, many providers won’t allow trial of labor (TOLAC) after one Cesarean, let alone two or three. It makes us so sad when we hear this, because many people who qualify for a vaginal birth are not given the option. Many times, they are not even informed on the differences between going for a vaginal birth vs scheduling a repeat C-section. 

In this article, I want to talk more about what VBA3C looks like, how it compares to VBA2C, and the evidence on safety of VBAC after 3 Cesareans. 

Am I a good candidate for VBAC after 3 C-sections? 

Providers can have different opinions on whether anyone “qualifies” for a VBA3C. However, they may consider the same factors as they would for any VBAC. The following may impact whether or not a provider views you as a good candidate:

• Have you had any previous vaginal births?
• Do you have a low transverse C-section scar?
• Do you have Diabetes or other health risk factors? 
• Have you reached 10 cm before?
• What were the reasons for your previous C-sections? Have you been “labeled” as failure to progress, failure to ascend, or diagnosed with CPD or small pelvis? 

Just like any vaginal birth after Cesarean, one of the most common concerns for providers is uterine rupture. Uterine rupture makes the idea of VBAC scary when it doesn’t necessarily need to be. In reality, it happens in less than 1% of pregnancies, and for VBAMC, slightly higher with an average rate of 1.2%. The studies on VBA3C are still very scant, but looking at these numbers, the risk of uterine rupture is still very low. 

If your provider is suggesting a fourth C-Section, and not offering a vaginal birth, ask them their thoughts on VBAC, and what options they offer surrounding it. 

Finding a great supporter will help. As a doula, Julie worked with a client, Shannon, who shared her VBAC after 3 C-sections story with us on The VBAC Link podcast. Shannon talks about how she had to change providers, because even one of the most supportive VBAC doctors in her area was hesitant about VBA3C. 

She found a very supportive VBAC friendly provider, and when she passed her due date by 9 days, her new provider suggested a repeat C-Section. She was told that due to the size of the baby and being past her due date, the chances of vaginal birth went down significantly to 10-15%. 

Despite being told that she will most likely have a very long labor and still end up in a C-Section, Shannon and her husband felt comfortable moving on with their plan for VBA3C. Make sure to listen to her incredible story on the podcast episode. 

Can you have a natural birth at home after 3 C-sections?

The American College of Obstetricians and Gynecologists (ACOG) produces practice guidelines we reference often. It does not suggest having a vaginal birth after Cesarean, let alone multiple Cesareans, out of the hospital. 

This can make it hard for parents who want to try for a VBA3C. More often than not, birthing parents do not feel the support they desire to have a vaginal birth after 3 C-Sections in a hospital setting. As a result, there are often parents who choose to birth in the comfort of their own home. 

In a study on out-of-hospital births titled Home Birth” with an Obstetrician, 32 parents decided to TOLAC out of the hospital. Three of these parents wanted a natural birth after 3 C-Sections. All three were successful. 

We are here to tell you that it is most definitely possible! 

What steps should I take to enhance my VBA3C chances? 

I would suggest all of these steps for ANYONE wanting to birth a certain way.

1. Decide what is best for you

Do you feel comfortable with the risks associated with VBAC? Feeling confident and comfortable is so important when you are deciding to VBAC. Although there may be worries or even doubts along the way, it is good to start off knowing the pros and cons of both repeat C-Section and VBAC.

2. Gather a supportive birth team

Having support during your journey is going to help, no matter how you choose to give birth. There are many benefits to hiring a doula, and we definitely suggest it. Doulas and other supportive people can help you on those days when you feel doubtful or worried.

You may hear comments and read social media posts that cause you to doubt your plans or need reassurance. Having a support team there gives you a chance to voice those feelings and fears instead of holding them in. Your team will also come in handy when labor begins. They can support you with counter pressure, education, and love.

3. Find a supportive VBAC Provider

As you may have heard in Shannon’s story or Taylor’s VBAC story, finding a supportive provider is super important when it comes to birthing, especially VBAC. They are able to help you during the process, and want to listen to your needs and how you are feeling, working with you in every way possible to help you have a successful VBAC. 

If you have a provider that is tolerant, but not supportive of VBAC, you may want to consider exploring your options for a more supportive provider. If you’re in an area that only has tolerant providers, give Allison’s episode a listen and learn how she navigated through VBAC with an unsupportive provider.

4. Get educated about your birth options

Education is a powerful tool when it comes to having a VBAC. There are a lot of myths and misconceptions about whether or not it is safe to VBAC. Having the education to back you up can help you eliminate the static, and will help you and your provider get on the same page. Education will help you have an educated discussion on your hopes and desires with your provider. 

We have created the online Ultimate VBAC prep course for parents to help you armor up with facts and beef up your education on VBAC. 

Making decisions on what is best for your next birth can be hard. Here at The VBAC Link we really want to help you along the way, as you determine what type of birth is best for you. 

We also recognize that VBAC is not always the best choice or option for everyone. We want you to feel loved, no matter what choices you make and how your birth unfolds. 

If you haven’t already, join our Facebook group The VBAC Link Community or our CBAC Link Community to be with birthers just like you.