The choice between vaginal birth after cesarean (VBAC, "vee-back") and repeat c-section is sometimes presented in black and white, with some holding the opinion that another cesarean is safest for your baby. It is true that the c-section scar can give way (uterine rupture) during labor and that this is on rare occasions life-threatening for the baby. The decision is not so simple, however, as a c-section also poses risks to babies. This website can help you consider the full range of risks involved when making your decision. You can find detailed information about these risks in Best Evidence: VBAC or Repeat C-Section and Best Evidence: C-Section.

Which is safer for me: planning a VBAC or a repeat c-section?

Both vaginal birth after cesarean and repeat c-section involve some increased risks to mothers. However, without a clear, compelling and well-supported need for c-section in the present pregnancy, planned vaginal birth is safer overall for you than a planned repeat c-section. With supportive care, 75 or more out of 100 women who plan VBAC give birth vaginally. The others go on to have another cesarean, primarily for reasons that are unrelated to the scar.

A planned cesarean offers some advantages over a cesarean that takes place after labor has started: a planned cesarean is less likely to involve injury to other organs during surgery, to lead to infection, and to take an emotional toll. Nonetheless, whether planned or unplanned, cesarean sections are major surgery and involve pain, a post-operative recovery period, and greater risk for mothers in many areas. You can find detailed information about these risks in Best Evidence: VBAC or Repeat C-Section and Best Evidence: C-Section.

Which will be safer for me and my babies in any future pregnancies: planning a VBAC or a repeat c-section in this pregnancy?

A VBAC in your current pregnancy is the far safer choice for any future pregnancies you may have. Each additional cesarean operation increases the amount of internal scar tissue. Increasing scar tissue makes it more and more difficult for the placenta that nourishes the baby to grow and attach normally. This can pose life-threatening risks to babies and mothers. Increasing scar tissue also increases the chance of adhesions, where nearby tissue or organs grow together. Adhesions make cesarean surgery more difficult and risky in future pregnancies. You can find detailed information about these risks in Best Evidence: VBAC or Repeat C-Section and Best Evidence: C-Section.

 

A VBAC this time around has other advantages in future pregnancies. If a woman who has a VBAC has more children, she almost always gives birth vaginally and her uterine scar almost never gives way during future labors.

Why is it important to support women's informed choices for VBAC or repeat c-section?

Even though many caregivers and hospitals do not offer VBAC, dozens of studies involving tens of thousands of women have concluded that planned VBAC is a reasonable choice in nearly all cases. Research makes it clear that both VBAC and repeat cesarean section have potential benefits and harms. Even if every woman understood clearly these harms and benefits, some would choose VBAC and others would choose repeat cesarean, because different women have different values, needs, and circumstances. Factors like the amount of postpartum support a woman will have, her plans for future children, her feelings about her first birth experience, and many others may weigh into a woman’s decision about VBAC. Every woman should have the opportunity to carefully weigh the benefits and potential hazards of planned c-section versus planned VBAC and make the decision she feels is right for her, her baby, and her family.

How does my right to "informed consent" or "informed refusal" relate to my decision about VBAC vs. repeat c-section?

Informed consent is a process to help you decide what will and will not be done to you and your body. In the case of maternity care, informed consent also gives you authority to decide about care that affects your baby. The purpose of informed consent is to respect your right to self-determination. It empowers you with the authority to decide what options are in the best interest of you and your baby. Your rights to autonomy, to the truth (as best as it can be known at the time), and to keep yourself and your children safe and free of harm are basic human rights. As the person receiving care and mother of your baby, you are in the best position to decide what risks are important to you.

Whether you wish to plan a VBAC or a repeat c-section, it is important to make this decision on the basis of complete, accurate, unbiased information. In practice, you will not always have access to your choice, as providers, hospitals and birth centers also have rights and may choose not to offer some types of care. However, others in your community or surrounding communities may offer the type of birth you want, including emotional support that addresses fears or anxieties that you may have.

How can I learn more about my specific situation?

It is essential that you seek information beyond what is provided here. Your caregivers are an important source of this information. If your caregiver proposes a repeat cesarean or a VBAC, ask:

• What is involved in this particular course of action?
• Are there any special considerations for my specific situation?
• What benefits do you believe the recommended care offers?
• What potential problems or disadvantages could there be?
• What are the pros and cons of the alternative route?

Your decision affects the likelihood of dozens of different risks that you, your baby, and any future babies will experience. You can learn about these in Best Evidence: VBAC or Repeat C-Section and Best Evidence: C-Section. Your caregiver can help answer questions about this information.

What if a cesarean is recommended for a new problem that is a not an urgent matter?

In many cases, where some caregivers would recommend a cesarean, others would disagree that a cesarean is necessary. When the situation is not urgent, you have time to discuss the advantages and disadvantages of a cesarean with your caregiver or get a second opinion. You can consult this website's separate Pregnancy Topic on Cesarean Section.