For parents who have previously given birth via cesarean, the option of a vaginal birth after cesarean (VBAC) in a subsequent pregnancy represents a deeply personal choice to pursue a different birth experience.
What it is
VBAC, or "vaginal birth after cesarean," refers to the process of attempting a vaginal birth following one or more prior cesarean deliveries. The medical term for this attempt is a "Trial of Labor After Cesarean," or TOLAC. It's an opportunity for parents to experience labor and vaginal birth, which can be a meaningful choice for many. Most commonly, VBAC is considered for individuals who have had one prior low transverse cesarean incision, which is the most common type of C-section incision and carries a lower risk profile for subsequent labor.
What the evidence says
Evidence strongly supports TOLAC as a safe option for most individuals with one prior low transverse cesarean. The American College of Obstetricians and Gynecologists (ACOG) reaffirmed this in their 2019 update. Research indicates that the VBAC success rate for appropriate candidates is approximately 70%. The primary consideration with TOLAC is the risk of uterine rupture, which is low—around 0.5–1% with one prior cesarean. This risk can be higher with multiple prior cesareans, induction using certain prostaglandins, or a short interpregnancy interval. For those with two prior cesareans (VBA2C), a VBAC is possible but carries increased risks, and not all providers or hospitals may support this option. Tools like the Grobman calculator can offer an estimated individual success likelihood, which can be a helpful component of shared decision-making with your care team.
When it's recommended
VBAC is recommended for individuals who are considered appropriate candidates based on their medical history, the type of their prior cesarean incision, and current pregnancy health. This decision is always made collaboratively with your care provider, considering your unique circumstances and preferences. It's about understanding the evidence and how it applies to your specific situation, allowing you to make an informed choice that feels right for you. Your provider will review your prior medical records to ensure you meet the general criteria for a safe trial of labor.
