GUIDE
About 60-80% of women who attempt a VBAC deliver vaginally — but candidacy depends on your specific history.
Understanding the evidence behind VBAC helps you have an informed conversation with your provider about the right choice for your next delivery.
Be prepared from day one
VBAC stands for vaginal birth after cesarean. If you have had one or more C-sections and are pregnant again, you may have the option of attempting a vaginal delivery for your next birth. The formal medical term for this attempt is TOLAC — trial of labor after cesarean.
Not every woman is a candidate for VBAC, and the decision involves weighing real risks against real benefits. But for those who qualify, VBAC has a strong success rate and significant advantages over a repeat C-section — especially for women planning future pregnancies.
The American College of Obstetricians and Gynecologists (ACOG) supports VBAC for most women with one prior low-transverse cesarean incision, and encourages providers and hospitals to offer it as an option. Here is what you need to know to have an informed discussion with your provider.
Your provider can calculate a personalized VBAC success score based on your history and current pregnancy factors.
The primary advantage of a successful VBAC is avoiding major surgery. Recovery from a vaginal delivery is significantly faster than recovery from a C-section. You can typically walk, lift, and care for older children within days rather than weeks.
For women planning multiple future pregnancies, VBAC is especially worth considering. Each additional C-section increases the risk of surgical complications, including placenta accreta (where the placenta grows into the uterine wall) — a potentially life-threatening condition. Avoiding an additional uterine scar can reduce these cumulative risks.
Babies born vaginally also benefit from exposure to maternal vaginal bacteria during delivery, which may support early microbiome development and immune function. They are also less likely to experience transient respiratory issues that can occur after cesarean delivery.
A successful VBAC offers significant recovery and long-term health advantages.
The risk that receives the most attention is uterine rupture — when the scar from your previous C-section opens during labor. This occurs in approximately 0.5-0.7% of VBAC attempts, or roughly 1 in 150-200 labors. While rare, uterine rupture is a medical emergency that requires immediate C-section and, in very rare cases, hysterectomy.
This is why VBAC should only be attempted at a hospital with the capability to perform an emergency cesarean within 30 minutes (the ACOG recommendation). Birthing centers and home births are not recommended for VBAC.
The other significant risk is that of a failed VBAC — laboring and then needing an unplanned C-section. An unplanned cesarean after hours of labor carries slightly higher risks (infection, blood loss) than a scheduled repeat C-section. About 20-40% of women who attempt a VBAC ultimately deliver by cesarean.
The absolute risk of uterine rupture is low, but the consequences can be serious. Facility readiness is critical.
For some women, the predictability and eliminated rupture risk of a planned C-section is the right choice.
Bring these questions to your prenatal visit: What was the type of incision on my uterus (not just the skin)? What is my estimated VBAC success rate? Does this hospital have 24/7 anesthesia and surgical teams? What monitoring will be used during labor? Under what circumstances would you recommend converting to a C-section?
If you and your provider decide VBAC is right for you, preparation is similar to preparing for any vaginal delivery. Review the stages of labor, consider your birth plan preferences, and pack your hospital bag with essentials for both a vaginal delivery and a possible C-section.
Taking a birthing class is especially valuable if your first birth was a planned cesarean and you have never experienced labor. Many hospitals offer VBAC-specific classes or support groups where you can connect with other women who have made this choice.
Spontaneous labor (labor that starts on its own) gives you the best chance of a successful VBAC. Some providers will offer induction for VBAC candidates, but with more restrictions on the methods used.
The VBAC versus repeat C-section decision is deeply personal. There is no universally "right" answer — only the right answer for your situation, your history, your comfort level, and your future family plans.
Some women feel strongly about experiencing vaginal birth. Others find comfort in the controlled nature of a scheduled cesarean. Both are valid choices. What matters most is that your decision is informed, supported by your provider, and made without pressure in either direction.
Whatever you choose, know that the goal is the same: a healthy delivery for you and your baby.
This guide is for informational purposes only and is not a substitute for professional medical advice. Always consult your healthcare provider with any questions about your pregnancy.
