As moms, we have to hold a lot of things in tension — and it begins from the day our babies join us in the world! For example, I’ll always talk about the importance of walking into your birthing suite feeling educated and empowered about your birth plan. At the same time, we all know that sometimes your birth plan doesn’t quite go to plan, and that’s okay too. We can advocate for ourselves while remaining open to what’s best for our bodies and our babies in the moment. 

If you’ve had a c-section, especially an unplanned one, you know firsthand just how true this is! Cesarean sections are a necessary step in some deliveries. But just because you had a c-section once does not necessarily mean you’re stuck with that delivery method for all future pregnancies. 

What is a VBAC?

Some multiple-time moms want to attempt a vaginal delivery again, even if their first childbirth experience resulted in a c-section. This is known as a VBAC, which stands for vaginal birth after cesarean. In fact, many women choose TOLAC, which stands for trial of labor after cesarean. Essentially, this refers to an attempt to deliver your baby vaginally after a prior c-section, regardless of the outcome.

Pros and cons of VBAC

If you’ve been told that all c-sections become repeat c-sections, you’ve been lied to! Of course, you should walk through the details with your care team and determine what’s best for you based on the reasons for your prior c-section and your current situation. But in general, research shows that a VBAC is actually “associated with decreased maternal morbidity and a decreased risk of complications in future pregnancies.” A c-section can come with complications from scarring, anesthesia, post-op infections, organ injury, and more.  

The pros of VBAC: 

• No major abdominal surgery
• Potential for a shorter hospital stay
• Potential for quicker recovery time 
• Experiencing vaginal delivery (if this is a pro for you!) 

The potential complications of VBAC:

The primary concern for VBAC deliveries is uterine rupture, although this occurs for less than 1% of women. There are three types of uterine incisions used in c-sections: low transverse, low vertical, and high vertical. If you had a high vertical incision, you have the highest risk of uterine rupture – but for those with either of the other two incisions, you could be a great candidate for VBAC. 

How long should you wait to get pregnant again if you want to try for a VBAC? 

If you have had a c-section and want to deliver your next baby vaginally, keep your interdelivery interval (IDI) in mind! Waiting at least 18 months between deliveries greatly increases your odds of preferable outcomes. In fact, waiting for an 18 month interpregnancy interval is even more optimal. 

What to know when considering VBAC

First, know that many women who attempt vaginal delivery (TOLAC) have a successful VBAC! 7 out of 10 women who had one cesarean delivery in the past were able to have a subsequent vaginal delivery. And even better news — women with multiple c-sections actually have similar rates of success as women with only one prior cesarean! VBAC-2, which indicates two prior c-sections, have a 71.1% success rate with just a 1.36% uterine rupture rate. The data remains steady for VBAC-3 women, too. 

If you’ve had a cesarean and you want to deliver vaginally, partnering with the right provider is absolutely essential. Find a supportive provider who has VBAC experience, because unfortunately, many providers are not as well-trained in or comfortable with VBACs in general, let alone VBAC-2, 3, or higher. 

Can you have a VBAC at home?

You may see or hear the term HBAC, which stands for home birth after cesarean. This is, of course, a type of VBAC! There are lots of reasons women prefer to have a baby at home. Some decide to experience their next delivery differently after their previous hospital delivery. Others wanted to have their first baby at home, but ended up needing to go to the hospital for a c-section. 

Interestingly, while severe adverse outcomes are rare in both settings, successful outcomes (meaning the woman was actually able to deliver vaginally instead of having another c-section) are much higher at home than in a hospital. According to the research, “home births for those eligible for VBACs and attended by registered midwives within an integrated health system were associated with higher vaginal birth rates compared with planned hospital VBACs” to the tune of 39%! 

If home birth is on your preferred birth plan, talk to your providers and care team to determine if this is a good plan for you, and know that the data is in your favor! 

What decreases your chances of a successful VBAC?

A VBAC can be a great decision for some expecting moms, but others may not be great candidates. These factors can limit your chances for a successful vaginal delivery: 

• Previous unsuccessful TOLAC 
• You have a high-risk pregnancy
• You’re 41+ weeks pregnant
• You’re 40+ years old
• Your BMI is greater than 30
• You have a large baby (8 pounds 14 ounces or more) 

If you’re concerned about one of these factors, talk to your provider to see if VBAC is still possible for you. 

What increases your chances of a successful VBAC?

Heal your c-section scar 

If you want to set yourself up for success for a future VBAC, you can start today! C-section scar mobilization is essential in helping you connect with your lower abdominals again, reduce pain and adhesions, and heal your scar. If you aren’t sure where to start, my Healing Your Cesarean Scar workshop is perfect for you!

Find a supportive provider

It’s worth mentioning twice: this is probably the most important aspect of a successful VBAC. When you have a provider (OB or midwife) with experience in VBACs who is supportive of your decision, you can focus fully on a healthy delivery, knowing that they will align with your preferences. Providers who are more reluctant are going to be quicker to jump to the decision for another cesarean, and having someone who is apprehensive in the room is not the energy you need while you’re trying to birth your baby. 

Practice pushing positions

The lithotomy position, when you lie on your back with your knees in stirrups, might be what you see on TV, but in real life, it increases your risk of episiotomy and severe perineal tears. Instead, opt for a quadruped or side-lying position, both of which allow the most sacral freedom and provide you with much-needed increased pelvic floor mobility. 

Practice pushing techniques

Your breathing matters so much in labor and delivery, so practice ahead of time! Learn the difference between open glottis breathing and closed glottis (valsalva maneuver) breathing. The latter “purple pushing” method is taught all over the place, but adding additional pressure and strain on your pelvic floor can lead to perineal tearing and pelvic organ prolapse — so I recommend using open glottis technique. 

Work on your hip and pelvic mobility 

If you’ve never delivered vaginally before, trust me when I say that your body will thank you for working on your mobility prior to pushing! Mobility exercises can help alleviate your discomfort during labor and reduce adverse outcomes during childbirth. 

Preparing for your next pregnancy 

Not sure how to improve your mobility, practice pushing, or figure out how to breathe correctly? I cover all of that and so much more in my Movement Through Labor and Delivery program! I developed this course alongside a trusted Certified Nurse Midwife, because we both believe in empowering women to learn all of their options, prepare well for birth, and advocate for themselves at every step of the journey!

Inside the program, you’ll find: 

• A dozen educational modules that cover inductions, pain management, breathing, pushing positions, and more
• PDF cheat sheets to bring right to the birthing suite
• Labor prep movement flows from week 36 forward to get your body ready for delivery
• Tips for talking to providers, setting yourself up for healing in the 4th trimester, and giving your support person hands-on techniques that actually work

All of this comes on a free app with lifetime access and a ton of community support from other incredible moms. Truly, I hope it’s the resource you need to walk into your next pregnancy, VBAC or not, with confidence and calm. Join the Movement Through Labor and Delivery program today!