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During a recent episode of the Healthful Woman podcast, Dr. Nathan Fox and guest Dr. Stephanie Melka discuss VBAC, or vaginal birth after cesarean. In this episode, they discuss the risks associated with VBAC, which patients are candidates for VBAC, and choosing between cesarean and vaginal deliveries.

VBAC vs. Repeat C-Section

Vaginal birth after cesarean (VBAC) refers to delivering a baby vaginally after a previous C-section, while TOLAC, or trial of labor after cesarean, describes the process of attempting labor in that setting. At Maternal Fetal Medicine Associates, this decision is approached with a focus on both safety and personalized care, recognizing that no two pregnancies, or patients, are exactly alike. Choosing between VBAC and a repeat cesarean is not simply a medical decision, but one that also reflects your preferences, past experiences, and future family plans.

Understanding the Risk of Uterine Rupture

VBAC has gone through decades of changing recommendations.  The primary concern with VBAC is uterine rupture, which occurs when the scar from a prior cesarean opens during labor. Although this is a serious complication that requires immediate medical attention, it is also rare. For most women with one prior low transverse cesarean, the risk is less than 1 percent. Even in those uncommon cases, severe outcomes for the mother or the baby are rare. This creates a unique situation in which the risk is significant but very low, making personal comfort with risk an important part of the decision. Dr. Fox shares, “The other things we really go into the likelihood of success, right? If you’re gonna try a VBAC, if someone has a 0% chance of success, she’s not gonna try. And if she has 100% chance, she’s more likely to try, obviously.”

Comparing VBAC and Repeat Cesarean

When deciding between VBAC and a planned repeat C-section, it helps to understand the range of possible aftermaths. A successful VBAC is often associated with a smoother recovery, less postoperative pain, and fewer complications in future pregnancies. However, attempting labor does carry the possibility of needing a C-section anyway, which can involve a more complex recovery than a scheduled procedure. On the other hand, a planned repeat cesarean offers predictability and avoids labor-related risks, but it is still a surgical procedure with its own considerations, including infection, bleeding, and scar tissue.

What Influences VBAC Success?

Several factors help guide whether VBAC is likely to be successful. The reason for your prior C-section plays a major role, as non-recurring reasons, such as breech positioning, tend to have higher success rates than labor-related issues, such as failure to progress. A history of prior vaginal delivery is one of the strongest predictors of success, often leading to very high likelihoods of achieving a VBAC. Dr. Fox shares, “As women get older, their risk of a C-section goes up. In all regards, that’s true even on a first baby. But with a VBAC in the same way, it lowers their success rate. It does not seem to increase the risk. It just lowers the success rate. And the same is true also for her weight, or BMI, or body mass index, as that goes higher, her chance of a vaginal delivery goes lower, or her chance of a C-section goes higher.”

Looking Ahead to Future Pregnancies

Your long-term family plans are an important part of this conversation. For women who plan to have multiple children, avoiding repeated cesareans may reduce the risk of complications in future pregnancies. For those who are nearing the end of having children, a repeat cesarean may be a more ideal option. Both perspectives are valid and should be part of the decision-making process.

Learn More

If you are interested in learning more about VBAC, listen to the full episode of the Healthful Woman podcast. For pregnancy care in New York, contact Maternal Fetal Medicine Associates today by completing the online contact form.

Maternal Fetal Medicine blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!