VBAC Facts: The Real Truth About VBAC

Trying to find evidence-based VBAC facts can be a nightmare. I have been there, scouring the internet for hours, not knowing how to determine if the information is backed by science or fear. It can be lonely, overwhelming, and confusing. 

That’s the main goal behind The VBAC Link, to bring all the evidence-based information into one, easy to find location. 

The choice to go after a VBAC or schedule a repeat Cesarean can be hard. Are you wondering if you are a good candidate for VBAC? Need to know all the VBAC facts and stats? Do you have questions about the VBAC success rate, and the pros and cons of VBAC vs repeat c-section? 

You are in the right place. This blog is just for you! 

Here are some quick VBAC stats for you:

• VBAC success rate is 60 to 80%
• VBAC rates have slowly increased from 12.4% in 2016 to 12.8% in 2017 and 13.3% in 2018.
• The risk for uterine rupture during VBAC is marginal at 0.2 – 1.4%
• Other risks for the mother and baby are the same as with normal vaginal birth.

Read on to get help weighing the pros and cons with up-to-date VBAC facts, so you can best determine how to have a successful VBAC for yourself. 

What is VBAC?

VBAC stands for “vaginal birth after Cesarean” and simply refers to giving birth vaginally after having had one or more Cesarean births. 

VBAC has quite a history, and can be very political in some parts of the birth world. There’s also a lot of misunderstanding surrounding it. For these reasons, it is very important to get educated on the facts and know the real risks for both VBAC and repeat Cesarean. 

Armed with knowledge, you will not only be able to make the best decision for your circumstances, but also find the right support team. 

“Many women are candidates for vaginal birth after cesarean (VBAC). In fact, research on women who attempt a trial of labor after cesarean (TOLAC) shows that about 60 to 80 percent have a successful vaginal delivery.”

Mayo Clinic Staff

VBAC Stats: What are the risks?

VBAC does not come without risks. While generally considered safer than a repeat Cesarean, there are some risks to be aware of before you make an informed choice for your birth. 

Uterine rupture

The biggest concern surrounding VBAC is uterine rupture. The chance of uterine rupture with a low-transverse or bikini cut incision is anywhere from 0.2% — 1.4%. 

Fortunately, most mothers and babies come out of a uterine rupture healthy and well. However, there is a risk of fetal demise or a catastrophic rupture. While the exact numbers are yet to be determined, it is estimated that 1.3 per 1,000 or .0013% of VBAC attempts will end in fetal demise. 

Risks of vaginal birth in general

Other than the risk of uterine rupture, VBAC is no different than a typical vaginal birth. The risks commonly associated with that are:

• Severe tearing or stretching, about a 3% chance
• Damage to the pelvic floor 20% chance
• Higher chance of temporary incontinence, 20% chance
• Shoulder dystocia
• Umbilical cord prolapse, 3.3 in 1,000

To understand the alternative, let’s compare with the risks involved in C-sections, and the additional risks of having multiple Cesarean deliveries.

Risks of repeat Cesareans

The risks of repeat Cesarean are higher than vaginal births, and increase with each Cesarean. In contrast, with VBAC, the risks go down with each vaginal birth. 

Let’s go over repeat C-section risks. The numbers below are in the context of a second Cesarean and get higher with each subsequent Cesarean.

Hemorrhage

Cesareans account for twice as much blood loss as a vaginal birth. 4% of birthing parents will suffer a severe hemorrhage during a Cesarean. 

Dense adhesions

Adhesions are bands of scar tissue on pelvic or abdominal organs like the bladder and bowels. This is the most common complication from Cesareans, especially repeat Cesareans. 

24.5% of second repeat Cesareans and 46.1% of third Cesareans develop dense adhesions, which can cause long-term health issues such as pelvic pain, pain during intimacy, infertility, bowel obstructions, and lower back pain. 

Maternal mortality

Parents are 3x more likely to die during a Cesarean than a vaginal birth. Every year, in the United States, 700-900 women die of childbirth-related causes, roughly 525-675 of those are parents who had a Cesarean.

Blood clots

“Researchers who analyzed 60 international studies found that women who had a C-section were four times more likely to develop a blood clot than women who delivered vaginally.” 

Blood clots can cause swelling, inflammation, pain, and in rare cases, death. 

Placenta Accreta

Placenta accreta is a serious complication where the placenta grows too deep, or even through, the uterine wall. Placenta accreta can cause preterm birth, hemorrhage, lung failure, and kidney failure. The more Cesarean births you have, the higher your chances of developing accreta get, up to 1% after a fourth Cesarean.

Breathing problems in the baby

Infants born via C-section are four times more likely to have breathing problems during the first several days of their lives. 

Bowel or bladder injury

The chances of injury to the bladder or bowels, like accidental cutting or damage to the ureter are anywhere from 0.5% to 1.0%.

General risks of major surgery

We need to remember that a C-section is a major surgery to the abdomen. Risks associated with major surgeries include:

• Allergic reactions to anesthesia
• Severe pain
• Pneumonia
• Blood clots
• Kidney issues
• Urinary tract infections
• Collapsed lung
• Death

Multiple Cesareans

The more Cesarean births an individual has, the higher these risks become. It is important to consider your desired family size when deciding whether or not to attempt a vaginal birth or have a repeat Cesarean.

For example, with a second birth, the risks of a VBAC and a repeat Cesarean are very similar, statistically speaking. 

For a third pregnancy, the risks of a third Cesarean are higher than the risks of a VBAC. By the time you reach a 5th and 6th Cesarean, you have a 1 in 3 chance of having major complications.

Who is a good candidate for VBAC?

Most women with a previous Cesarean are great candidates for a VBAC. The ultimate decision is up to you, with guidance from a trusted care provider. 

Here are some factors that indicate a good candidate for VBAC:

• Low risk pregnancy
• A low transverse incision from the previous C-section (although those with special scars can still VBAC).
• Carrying a single baby
• Having just one or two Cesarean births (although VBAMC parents can still VBAC)
• Having had a previous vaginal delivery, either before or after your Cesarean, gives providers more confidence that you will be able to VBAC. 
• How long you wait between your C-section and next pregnancy may also play a factor. 
• Being in good health overall, and not having placenta issues, positively affect your chances for a VBAC. 

Deciding whether to try for a VBAC

Having a VBAC is a safe and reasonable choice for most women. You have a high chance of success and an even better one with the right support team. 

However, deciding whether to TOLAC (trial of labor after Cesarean) or schedule a RCS (repeat Cesarean) is a very personal decision. It should be made with a provider you trust, and based on your individual circumstances and preferences.

I always recommend learning as much as you possibly can about VBAC and repeat Cesarean, so you can make an informed choice. With up-to-date VBAC facts, you can trust your instincts and find a provider that believes in your decision 100%. 

Generally speaking, the benefits of VBAC outweigh those of repeat Cesareans. If your intuition tells you something is not quite right about either choice, listen to that. Figure out what is making you uncomfortable and make appropriate plans that make you feel safe. 

Finding the right support for your birth choices is important. Some areas have VBAC bans, and don’t allow VBACs in their hospitals. Other areas that do allow VBAC might not have a provider that is 100% supportive. Some parents even choose to travel several hours to find the best provider and birth location. All these things will be important to consider as you make your choice. 

Increasing your chances of a successful VBAC

There are a lot of things you can do to increase your chances of having a VBAC. Most importantly, learn about your options and know the facts about VBAC. 

That is why we created our signature course, How to VBAC: The Ultimate Prep Course for Parents, so you can find all the information you need in one convenient, self-paced, online video course. 

Some more actions you can take to increase your chances of a successful VBAC are:

• Find a provider that believes in you and your ability to have a vaginal birth. Talk to as many as you need to.
• Hire a doula with VBAC experience to guide you on your journey.
• Trust in your body AND your intuition.
• Allow labor to start on its own, unless medically necessary.
• Avoid aggressive induction methods and interventions when possible.

We cover all of those in more detail in the course, along with plenty of resources to help you get the support you need from your family and health team, going into your VBAC.

Learn more about your birth options

Finding a provider that is honest and truthful with you about your birth choices is key in getting the birth experience you desire. 

Find out what the policies on VBAC are in your provider’s practice and at your birth location. Even looking up a hospital’s Cesarean rate will help you find a supportive birth location. 

It is important to have an ongoing discussion about your plans with your provider, because things may shift during your pregnancy. Avoiding a bait and switch and knowing what those signs are in a provider will help guide your journey. 

For example, if a provider insists you have your baby by your due date or they will schedule a C-section, that policy is not evidence-based. It is perfectly safe for birthing parents to go past their due dates and to be induced for a VBAC.

Taking our prenatal class focused primarily on VBAC will help you become better educated about all of the things listed above. 

Frequently asked questions

Is VBAC safer than repeat Cesarean?

Generally speaking, VBAC is associated with fewer risks and complications than a scheduled Cesarean. ACOG has taken the stance that VBAC is safer than a repeat Cesarean, and VBA2C (VBAC after two Cesareans) does not pose a significant increase in risk. 

Why is a VBAC dangerous?

The biggest and most controversial issue around VBAC is uterine rupture. The chance of that happening is around 0.5%, and most uterine ruptures end with a healthy mom and baby. There is a small chance, about 1 in 1000, of loss of infant or maternal life due to rupture. 

How common is uterine rupture?

The chance of uterine rupture with a low-transverse or bikini-cut incision is anywhere from 0.2% to 1.4%.

How can I increase my chances of successful VBAC?

You can increase your chances of having a successful VBAC by educating yourself on the risks, having a VBAC supportive provider, and trusting your intuition to guide you along the way. 

What is the success rate of VBAC?

According to the APA, 60% to 80% of parents who attempt a VBAC will be successful. 

Who is a good candidate for VBAC?

Women with a low-risk pregnancy, a low transverse incision, and in generally good health are great VBAC candidates. 

Is VBAC worth the risk?

Deciding to VBAC is a very personal decision. It is important to have all the facts about both modes of delivery to make an informed decision. Generally speaking, VBAC is associated with better birth outcomes than repeat Cesarean for both mother and baby.