Alia Bucciarelli, MS
Vaginal birth after cesarean section (VBAC) is
giving birth vaginally after having a baby in an earlier pregnancy by
The goal of this procedure is to give birth vaginally, rather than through an elective C-section. Many women who have had a C-section in the past can deliver future babies vaginally with a low risk of complications.
If you are planning to have a VBAC, your doctor will review a list of possible complications, which may include:
Some factors that may increase the risk of complications include:
During pregnancy, you should:
Before "true" labor begins, you may have periods of "false" labor. These are irregular contractions of your uterus, called Braxton Hicks contractions. They are normal, but can be painful.
Timing the contractions is a good way to tell the difference between true and false labor. Note how long it is from the start of one contraction to the start of the next one. Keep a record for an hour. If the contractions are getting closer together, longer, and stronger, then it may be true labor. If you think you are in labor, call your doctor.
During this process, you will prepare to deliver your baby.
At the beginning of labor, the uterus will begin to contract, moving the baby down the vagina (birth canal).
The cervix, the opening of the uterus into the vagina, will slowly enlarge to a diameter of about 10 centimeters. This will allow the baby to pass through and be delivered through the opening of the vagina.
Labor can cause severe pain. While planning the delivery, talk to your doctor about your options for pain relief. In the beginning stages of labor, relaxation techniques (like meditation and rhythmic breathing) may be helpful. Keep in mind that every woman's labor is different and everyone experiences pain differently.
There are many medical options for pain control.
All treatments to relieve pain during labor have risks and benefits. Make sure you discuss these with your doctor.
Once the cervix is fully dilated (opened) and the baby seems to be heading down the birth canal, the nurses will help prepare you for delivery. Your legs may be draped with cloths. Some doctors will clean the area around the vagina with an antiseptic solution.
You may put your legs into holders, especially if you have an epidural. The nurses and your support people may hold your legs in a comfortable position. This will help you to push. Your doctor may encourage you to find a position that is right for you. Each time you have a contraction, you will be instructed to push. This involves bearing down like you are trying to have a bowel movement.
"Crowning" is when the baby's head is seen at the opening to the vagina. When this happens, you may be asked to slow your pushing. Depending on your delivery plan, the doctor may massage your perineum to gently stretch it. An episiotomy is not routinely done, but in some cases, it is necessary.
Once your baby's head is out, you will be asked to stop pushing. The doctor will check to make sure that the umbilical cord is not around the baby's neck. Then, you will be able to push the rest of the baby out. If the baby appears healthy and is breathing well, he may be placed on your stomach. The umbilical cord will be clamped and cut. Within the next 20 minutes, the placenta will be delivered.
Sometimes the baby's head does not move as expected through the birth canal. If this happens, your doctor may use forceps or vacuum extraction to move the baby. These will only be used if the baby is most of the way through the birth canal.
You may have the following:
This is extremely variable. The average time for you to deliver your first baby vaginally is 12 hours.
Labor causes severe pain. Talk to your doctor about your options for managing the pain.
The usual length of stay for a vaginal delivery is 1-3 days. Your doctor may choose to keep you longer, however, if complications arise.
Having a baby will change you physically and emotionally.
Physically, you might have the following:
Emotionally, you may be feeling:
After you leave the hospital, contact your doctor if any of the following occurs:
In case of an emergency, call for medical help right away.
American Academy of Family Physicians
Women's Health Matters
The American College of Obstetricians and Gynecologists. Vaginal birth after previous cesarean section.
Practice Bulletin. July 2004.
Landon MB. Maternal and perinatal outcomes associated with a trial of labor after prior Cesarean delivery.
N Engl J Med. 2004;351:2581-2589.
Trial of labor after cesarean (TOLAC), formerly trial of labor versus elective repeat cesarean section for the women with a previous cesarean section. The American Academy of Family Physicians website. Available at
http://www.aafp.org/PreBuilt/clinicalrec_tolac.pdf. Accessed August 31, 2005.
Vaginal birth after C-section. MayoClinic.com website. Available at:
http://www.mayoclinic.com/invoke.cfm?objectid=AEB2CFEE-5ECD-41DF-80F6314B6CF6B266. Accessed August 19, 2005.
Vaginal Birth After Previous Cesarean Delivery.
The American Congress of Obstetricians and Gynecologists, Practice Bulletin No. 115. August 2010.
Last reviewed November 2012 by Andrea Chisholm, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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