VBAC Guide
Most people with one prior low‑transverse cesarean can safely plan a VBAC (trial of labor after cesarean, TOLAC) in a hospital that’s prepared for emergencies. Typical success is about 60–80%, highest when you’ve had a prior vaginal birth, you go into labor on your own, and your current pregnancy doesn’t have new complications. Induction is possible but needs a hospital‑specific plan. Below is a practical prep guide; for step‑by‑step scripts and a personalized plan, join the Free VBAC Workshop.
At a glance
Good candidates: One prior low‑transverse cesarean, head‑down baby, no new complications; hospital with immediate cesarean capability
Typical success: ~60–80% (higher with prior vaginal birth)
Main risk: Uterine rupture is rare (~0.5%); risk is lowest with spontaneous labor; some induction methods raise risk
Pain relief: Epidurals are allowed and do not reduce VBAC success
Place matters: Choose a hospital that supports VBAC and can move quickly if needed
Scope note: Doulas provide non‑medical support and work with your clinical team.
Why many families choose VBAC
Shorter recovery and easier newborn care
Fewer surgical risks now and in future pregnancies (fewer adhesions, lower placenta previa/accreta risk)
Higher chance of vaginal birth in future pregnancies
Who is likely a good candidate (hospital criteria)
Scar type: One prior low‑transverse uterine incision (most common). Low‑vertical can sometimes be eligible; classical (high vertical) or prior uterine rupture usually means repeat cesarean.
Records: Bring your operative report if possible; when unknown, many are still candidates if a classical incision is unlikely.
Facility: Hospital with 24/7 anesthesia, blood bank, and rapid OR access; continuous fetal monitoring available.
How to prepare (step‑by‑step)
Collect your records. Ask for your prior cesarean operative report and prenatal records.
Book a VBAC consult with your provider and your doula. Clarify your eligibility, hospital policies, and on‑call coverage.
Make a one‑page VBAC plan (hospital‑ready). Include your top 3 priorities, monitoring, pain preferences, and induction/augmentation boundaries.
Optimize basics: Sleep, hydration, movement, and guideline‑aligned weight gain; manage blood pressure/diabetes if present.
Line up continuous support. A trained support person/doula is linked with higher spontaneous vaginal birth and lower cesarean rates.
Timing: VBACs do best with spontaneous labor. If induction is needed, discuss mechanical methods (Foley)and low‑dose oxytocin; avoid methods your hospital flags as higher risk for prior‑cesarean scars.
Know your cues. Review signs of labor, when to come in, and what changes your plan (bleeding, fever, decreased movement, etc.).
What improves your chances (evidence‑informed)
A prior vaginal birth (especially a prior VBAC)
Spontaneous labor (not induced)
Favorable cervix at admission
Longer interval since last cesarean (roughly ≥18–19 months)
Reason for prior cesarean is unlikely to recur (e.g., breech last time)
Supportive team & setting (hospital that actively offers VBAC; doula/partner with a clear role)
What can lower your chances (and what you can do)
Induction/augmentation: Raises rupture risk and lowers success vs spontaneous labor. If needed: Prefer mechanical methods (Foley/AROM) and careful oxytocin with senior oversight.
Higher BMI or preeclampsia: Doesn’t rule out VBAC—plan earlier optimization and tight blood pressure follow‑up.
Suspected big baby or >40 weeks: Can lower success odds; not an automatic “no.” Discuss timing, monitoring, and expectant management vs induction.
Induction & augmentation in a prior‑cesarean labor
Allowed in many hospitals with experienced teams.
Safer options: Foley catheter (balloon), amniotomy, and low‑dose oxytocin with continuous monitoring.
Avoid: Certain prostaglandins (e.g., misoprostol at term) due to higher rupture risk. Ask what your unit uses.
Epidural? Fine to use; it does not hide the signs of rupture—teams watch the fetal heart tracing most closely.
Safety checks on arrival (what to expect)
Continuous fetal monitoring from active labor
IV access and labs per hospital protocol
Clear handoff across shift changes (bring your one‑page plan)
Shared decisions if labor stalls: position changes, rest, fluids, amniotomy/oxytocin, or cesarean if needed
FAQ (fast answers)
What’s the chance I’ll have a successful VBAC? About 60–80% overall; 85–90% if you’ve had a prior vaginal birth.
What’s the main risk? Uterine rupture, which is rare (~0.5%) overall and lower with spontaneous labor. Hospitals that offer VBAC are set up to act quickly if this occurs.
Can I be induced? Yes in many settings, with a hospital‑specific plan (mechanical methods and careful oxytocin). Some medications (certain prostaglandins) are typically avoided at term after a cesarean.
Can I have an epidural? Yes—epidurals are not linked to lower VBAC success.
What if I’ve had two cesareans? Some hospitals offer TOLAC after two low‑transverse cesareans; risks are a bit higher and require senior review.
Does the VBAC calculator decide for me? No. Newer calculators don’t use race/ethnicity and are decision aids, not gatekeepers.
Work with Melancentric
VBAC Workshop - Free Virtual Workshops
1:1 VBAC Prep Visit (90 minutes): Personalized plan, hospital‑ready one‑pager, partner roles, and induction/augmentation preferences
Contact
Call/Text: 619‑379‑0011
Email: info.thefullspectrumdoula@gmail.com
Sources
ACOG Practice Bulletin “Vaginal Birth After Cesarean Delivery” (No. 205) — success predictors; induction/augmentation and rupture risk; epidural OK; >40 weeks not a hard stop
ACOG Practice Advisory (2021) — VBAC calculator as a discussion aid; do not use as a barrier; revised (no race/ethnicity)
ACOG Patient Education (2023) — hospital resource readiness; inter‑delivery interval (<19 months) lowers success
RCOG Green‑top Guideline No. 45 — ~0.5% rupture risk; 72–75% success overall; 85–90% with prior vaginal birth; mechanical induction methods may have lower rupture risk than prostaglandins
Cochrane Review (continuous labor support) — higher spontaneous vaginal birth; lower cesarean; improved satisfaction (supports doula role)
