What Moms Need to Know About VBACs

If you have had a previous cesarean birth, you may be curious about having a VBAC – short for Vaginal Birth After Cesarean for your next birth. 

But what exactly does a VBAC involve? And how can you know if it’s the right choice for you? 

In this article, we’ll discuss the facts, risks, benefits, and important questions to consider when thinking about a VBAC. 

What Is a VBAC? 

VBAC is the abbreviation for Vaginal Birth After Cesarean. For many years, the saying “once a cesarean, always a cesarean” was widely accepted. But research has since shown that vaginal birth after a cesarean is a safe and reasonable option for many women (1). 

You may also sometimes hear the term TOLAC (a Trial of Labor After Cesarean), which means attempting labor with the goal of a vaginal birth (1). If successful, it becomes a VBAC. If complications arise or the baby doesn’t tolerate labor well, a repeat cesarean may still be performed. 

If you’re preparing for a cesarean birth, or you’ve recently had one, read this article: What is a Gentle Cesarean? 

Why Consider a VBAC? 

There are many reasons mothers may choose to consider a vaginal birth after a c-section. Our birth preferences are individual, and what one mom sees as a priority, may not be a priority to another. Below are some of the reasons mothers may choose to consider a VBAC (2). 

Shorter Recovery Time 

Cesarean birth is major abdominal surgery, and recovery often involves more physical limitations and a longer healing period. One of the biggest motivators for choosing a VBAC is the potential for a faster, easier recovery (2). While all mothers deserve rest and support no matter how they give birth, a vaginal birth may allow you to be up and moving sooner—especially helpful when you have older children at home. 

To learn more about c-section recovery, read this article: A Holistic Approach To Healing After C-Section

Reduced Risk in Future Pregnancies 

The more cesareans a woman has, the greater the risk of complications like placenta previa (3,4), placenta accreta (4), and surgical injury in future pregnancies (4). Choosing VBAC, when safe and appropriate, may help reduce these risks and preserve options for future births. 

Empowerment and Emotional Healing 

Not all mothers feel the need to “heal” from a cesarean birth—cesarean delivery is a valid and often life-saving way to bring a baby into the world. But for some, especially those whose previous cesarean was unexpected or emotionally difficult, planning a VBAC can feel deeply empowering. If having a vaginal birth is something that matters to you, pursuing a VBAC can be a powerful part of your journey. 

If you are struggling emotionally during pregnancy or postpartum, please know that there is support available to you. I have a few articles that I hope can be a helpful resource for you, too:

• Understanding and Managing Postpartum Anxiety
• Identifying and Managing Postpartum Depression 

What Are the Risks Associated with VBAC? 

VBAC is a safe and evidence-supported option for many women—but like all birth choices, it comes with some potential risks. Understanding these helps you make informed decisions and feel more prepared for whatever your birth may bring. 

VBAC & Uterine Rupture 

The most serious potential complication of a VBAC is uterine rupture, where the scar from a prior cesarean opens during labor. This can lead to heavy bleeding and may affect both the mother and the baby. Fortunately, uterine rupture is rare, occurring in less than 1% of cases for those with a low transverse (horizontal) uterine incision, which is the most common type used today. The risk of rupture does increase with multiple prior cesareans, especially if a woman has had two or more surgeries without a previous vaginal birth (5).  

Risk of Unplanned Repeat Cesarean 

Attempting a VBAC doesn’t guarantee that vaginal birth will be achieved. About 20–40% of women who begin a trial of labor after cesarean (TOLAC) ultimately need a repeat cesarean (6). This can happen if labor stalls, if baby’s heart rate becomes concerning, or for other medical reasons.  

Who’s a Good Candidate for a VBAC? 

VBAC can be a safe and successful option for many women—but it’s not for everyone. Your individual medical history, the details of your previous cesarean, and your current pregnancy all play a role in determining whether VBAC is a good choice for you (7). 

You may be a strong candidate for a VBAC if: 

1. Your previous cesarean used a low transverse incision. 

This is the most common type of uterine incision (a horizontal cut across the lower part of the uterus) and is associated with the lowest risk of uterine rupture (8). If your operative report confirms this, you’re more likely to be cleared for VBAC. 

2. You’ve had only one prior cesarean.

VBAC after one prior cesarean is well-studied and generally supported. Some providers also offer VBAC after two cesareans (known as VBA2C) (9), especially if you’ve also had a successful vaginal delivery. 

3. You haven’t had other uterine surgeries. 

Procedures like fibroid removal (myomectomy) (10) or classical cesarean incisions (vertical cuts on the upper uterus) increase the risk of uterine rupture (11) and often rule out VBAC for safety reasons. 

4. You’ve had a previous vaginal birth. 

If you’ve had a vaginal birth before or after your cesarean, your chances of a successful VBAC are even higher, often exceeding 80% (12). Your body has already shown it can birth vaginally, which providers consider a strong indicator of success. 

5. Your current pregnancy is low-risk. 

You’re more likely to be a candidate if your pregnancy is free from major complications, your baby is head-down at term (cephalic position), and there are no signs of fetal distress, placenta previa, or growth concerns. 

What Might Lower Your Chances of VBAC Success? 

Some factors may slightly reduce your likelihood of a successful VBAC or increase the level of monitoring your provider recommends, including: 

• High BMI (13) 
• Short interval between pregnancies (especially less than 18 months)* (14) 
• Post-term pregnancy (past 41–42 weeks) (15) 

*Interval between pregnancies is typically measured as the time between birth and conception. 

These factors do not automatically disqualify you from VBAC, but they may influence your provider’s recommendations or the birth setting. Some hospitals have strict protocols about who can attempt a VBAC, while others are more flexible. It’s essential to have open conversations with your provider about your unique circumstances. 

How Likely Is VBAC to Succeed? 

The overall success rate for VBAC is 60–80% (12), which is comparable to first-time vaginal births. Women who have had a vaginal birth before, especially after a cesarean, have even higher chances of success (12). 

Planning for a VBAC: Choosing a Provider 

One of the most important factors in having a safe and successful VBAC is being surrounded by a birth team that truly supports your goal. Not all hospitals or providers offer VBACs, and among those who do, the level of support can vary widely. Some may say they’re “VBAC-friendly,” but have strict timelines, quick triggers for surgery, or policies that limit your options once labor begins. 

Choosing a team that not only allows VBAC but actively supports and believes in it can make all the difference. 

To learn more about assembling a supporting birth team, read this article: Assembling Your Birth Team: Who’s Who & How to Choose The Right Support For Your Pregnancy 

Questions to Ask Your Provider When Exploring VBAC 

If you’re considering a VBAC, it’s okay to ask direct, thoughtful questions like: 

• “Do you support VBACs, and what is your success rate?” 
• “How often do your VBAC patients end up with repeat cesareans?” 
• “What are the hospital policies around VBAC and labor timelines?” 
• “Are there any circumstances where you would not allow me to attempt a VBAC?” 
• “Is emergency surgical support available 24/7 at the hospital where I’ll deliver?” 
• “Will I be allowed to move freely in labor, use water (like the shower or tub), or eat and drink?” 

Having a VBAC at Home? 

Some families explore the possibility of home birth after cesarean (HBAC) as an alternative to hospital-based care. While large-scale research on HBAC outcomes is limited, existing data suggest that planned home birth with a qualified provider in low-risk pregnancies may carry similar outcomes to planned hospital births (16).  

It’s important to know that not all midwives attend VBACs at home, and a planned home VBAC may not be legal in all areas. If you’re considering HBAC, seek out a provider trained in out-of-hospital VBAC, and discuss how they assess risk, monitor labor, and handle transfers. 

Summary 

VBAC, or Vaginal Birth After Cesarean, is a safe and empowering option for many women who’ve had a previous c-section. It can offer benefits like a quicker recovery, fewer complications in future pregnancies, and the opportunity for a vaginal birth experience if that’s something you value. With the right support team and a thoughtful approach to planning, many women go on to have smooth and positive VBACs. Understanding your options, asking the right questions, and partnering with a provider who truly supports your goals can help you feel confident and well-prepared for whatever your birth journey brings. 

References: 

1. Habak PJ, Khaparde G, Vadakekut ES. Vaginal Birth After Cesarean Delivery. [Updated 2025 Feb 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507844/ 
2. American College of Obstetricians and Gynecologists. (2017). Vaginal Birth After Cesarean Delivery (VBAC). Acog.org. http://acog.org/womens-health/faqs/vaginal-birth-after-cesarean-delivery 
3. Hancerliogullari N, Yaman S, Aksoy RT, Tokmak A. Does an increased number of cesarean sections result in greater risk for mother and baby in low-risk, late preterm and term deliveries? Pak J Med Sci. 2019 Jan-Feb;35(1):10-16. doi: 10.12669/pjms.35.1.364. PMID: 30881388; PMCID: PMC6408670. 
4. Alshehri KA, Ammar AA, Aldhubabian MA, Al-Zanbaqi MS, Felimban AA, Alshuaibi MK, Oraif A. Outcomes and Complications After Repeat Cesarean Sections Among King Abdulaziz University Hospital Patients. Mater Sociomed. 2019 Jun;31(2):119-124. doi: 10.5455/msm.2019.31.119-124. PMID: 31452637; PMCID: PMC6690310. 
5. Togioka BM, Tonismae T. Uterine Rupture. [Updated 2023 Jul 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559209/ 
6. Habak PJ, Khaparde G, Vadakekut ES. Vaginal Birth After Cesarean Delivery. [Updated 2025 Feb 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507844/ 
7. The Maternal Fetal Medicine Units Network. (2023). Vaginal Birth After Cesarean Calculator – portal (MFMU). Mfmunetwork.bsc.gwu.edu. https://mfmunetwork.bsc.gwu.edu/web/mfmunetwork/vaginal-birth-after-cesarean-calculator 
8. Schutterman EB, Grimes DA. Comparative safety of the low transverse versus the low vertical uterine incision for cesarean delivery of breech infants. Obstet Gynecol. 1983 May;61(5):593-7. PMID: 6835613. 
9. Tahseen S, Griffiths M. Vaginal birth after two caesarean sections (VBAC-2)-a systematic review with meta-analysis of success rate and adverse outcomes of VBAC-2 versus VBAC-1 and repeat (third) caesarean sections. BJOG. 2010 Jan;117(1):5-19. doi: 10.1111/j.1471-0528.2009.02351.x. PMID: 19781046. 
10. Odejinmi F, Strong S, Sideris M, Mallick R. Caesarean section in women following an abdominal myomectomy: a choice or a need? Facts Views Vis Obgyn. 2020 May 7;12(1):57-60. PMID: 32696025; PMCID: PMC7363247. 
11. Kan A. Classical Cesarean Section. Surg J (N Y). 2020 Feb 6;6(Suppl 2):S98-S103. doi: 10.1055/s-0039-3402072. PMID: 32760792; PMCID: PMC7396476. 
12. Cheng YW, Eden KB, Marshall N, Pereira L, Caughey AB, Guise JM. Delivery after prior cesarean: maternal morbidity and mortality. Clin Perinatol. 2011 Jun;38(2):297-309. doi: 10.1016/j.clp.2011.03.012. PMID: 21645797; PMCID: PMC3428794. 
13. Juhasz G, Gyamfi C, Gyamfi P, Tocce K, Stone JL. Effect of body mass index and excessive weight gain on success of vaginal birth after cesarean delivery. Obstet Gynecol. 2005 Oct;106(4):741-6. doi: 10.1097/01.AOG.0000177972.32941.65. PMID: 16199630. 
14. Stamilio DM, DeFranco E, Paré E, Odibo AO, Peipert JF, Allsworth JE, Stevens E, Macones GA. Short interpregnancy interval: risk of uterine rupture and complications of vaginal birth after cesarean delivery. Obstet Gynecol. 2007 Nov;110(5):1075-82. doi: 10.1097/01.AOG.0000286759.49895.46. PMID: 17978122. 
15. Coassolo KM, Stamilio DM, Paré E, Peipert JF, Stevens E, Nelson DB, Macones GA. Safety and efficacy of vaginal birth after cesarean attempts at or beyond 40 weeks of gestation. Obstet Gynecol. 2005 Oct;106(4):700-6. doi: 10.1097/01.AOG.0000179389.82986.50. PMID: 16199624. 
16. Olsen O, Clausen JA. Planned hospital birth compared with planned home birth for pregnant women at low risk of complications. Cochrane Database Syst Rev. 2023 Mar 8;3(3):CD000352. doi: 10.1002/14651858.CD000352.pub3. PMID: 36884026; PMCID: PMC9994459.