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Cesarean Doesn't Mean Forever

Many American women deliver their babies by cesarean birth, which means the baby is born through a surgical incision made in the mother's abdomen and uterus. At one time it was thought that once a woman had a cesarean birth, she would always have a cesarean birth in any subsequent pregnancies.

Today, that thinking is changing. Many women who have had cesarean births can attempt to deliver vaginally (referred to as a VBAC or vaginal birth after cesarean) if no risk factors are present. In fact, 60 to 80 percent of these women go on to have successful vaginal deliveries.

According to the American College of Obstetricians and Gynecologists, VBAC can be a safe option for many women. However, it is not the right choice for all women, and there are some risks.

Why attempt vaginal delivery?

  • Less risk. A vaginal delivery usually has fewer complications for the mother than cesarean birth. A cesarean delivery requires major surgery and is performed under anesthesia. With a vaginal birth, there is no abdominal incision, so there are none of the risks associated with surgery, and the anesthesia risks tend to be lower. The major risks of VBAC are that the cesarean scar may tear during delivery or that the uterus will tear (rupture). Some types of incisions used in cesarean deliveries are more likely to rupture during vaginal delivery than others.

  • Shorter recovery. The mother's stay in the hospital often is shorter after a vaginal delivery, and she usually will have less discomfort than after a cesarean birth. Recovery at home is usually faster after a vaginal birth, too.

  • More involvement. Some women wish to be awake and fully involved in the birth process. Since general anesthesia is sometimes used during cesarean delivery, the mother cannot always remain awake and experience the actual birth. There also may be more limits on the presence of others in the delivery room during a cesarean birth.

Other factors

Of course, there are a number of other factors to consider before you and your doctor decide if you are a good candidate for VBAC delivery. The factors that could influence your decision include the type of incision made in the uterus during previous cesarean birth(s), multiple births, the size and position of the baby in the womb, and medical conditions such as high blood pressure or diabetes. Most hospitals are now requiring a separate consent to be signed for a vaginal birth if a woman has had a previous cesarean birth. Women attempting a VBAC should begin labor with close medical supervision in a hospital capable of emergency C-sections. VBAC should only be attempted in a hospital where an emergency C-section can be set up in less than 30 minutes.