To VBAC or not to VBAC

Advice about whether to have another C-section or try for a Vaginal Birth After C-section (VBAC).


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Original Poster: 


"Thanks again to everyone who responded to my post with their vbac advice and/or experiences. I am so grateful for this community support system! Below is a summary of responses for those who asked me to post to the list - I hope you will find them as helpful as I did. (It is very long due to the many thoughtful responses!)
Thanks again."


Full Replies:


"I tried for a VBAC and ended up with a c-section. My first birth was induced and I didn't dilate. I waited, waited, waited, suffered, suffered, didn't get an epidural and in the end had the c-section.
My second time was different. I went into labor on my own, labored thru intense back labor, got an epidural at 4 centimeters, made it to 7 centimeters and then chose a c-section because my baby wasn't descending. His head was down, but it was facing the wrong way and wouldn't allow his body to descend. I didn't wait and wait this second time. I gave it a reasonable amount of time and when the epidural was wearing off and I could feel the pain again, I chose to end the suffering. Both my babies were healthy, strong.
That's my story. If I were doing it over again, I would definitely try for a VBAC. It wasn't scary. I felt (somewhat) in control--you know how hospitals are... recovery from the c-section the second time was super fast and easy. Much better than my first. I also knew what to expect and that makes all the difference.
What's important is to go with the decision that makes you feel comfortable and safe. There is no right or wrong."


"I did not have VABC but many of my friends went for it and were very happy they did. Every labor is different and so is every birth and in the end it is still better for you and your a baby to have gone through labor. 15% is an arbitrary number and your real chances are probably much higher than that - in my last labor with #3 I was really afraid that I would end up with C-section as I ended up in the hospital 4 weeks early with heavy bleeding and hardly any contractions. My OB considered it pre-labor and wanted the hospital to release me and let me walk around for a few hours - which they did not do. Yet, with much prayer, a wonderful nurse and a very helpful husband my son was born six hours later and just minutes after OB showed up - much to everyone's surprise naturally and very healthy!
You never know what our real chances are until you try - you win either way."


"I had a similar prognosis from my OB this past year. My labor with my son failed to progress, despite LOTS of very strong contractions, my water breaking etc. So, while it
was not an emergency, I opted for a C section. This spring my OB said there was a 70 percent chance my labor the second time would be the same: not progress and end up with a C section. Plus, he said usually the second birth benefits from the first birth in that the second is usually shorter, less painful (ha!) etc.
Because I didn't deliver vaginally for the first birth, none of the benefits from the first would apply to the second. In other words, it would be like delivering for the first time.
With those odds I chose an elective C section. The recovery was much, much better this time right from the beginning."


"It may depend on how you got to fully dialated. Induction or pitocin/ epidural can sometimes lead to failure to progress. Many others will weigh in, in sure, but if you decide to vbac, a doula would be a helpful addition to the team. Also, though you like your doc, do find out how many sucessful/attempted vbacs she does. Like any other procedure, the care provider's experience is essential. She may be the right vbac provider or not, but it's good to get the stats."


"It's a tough decision because everyone has such different experiences."


"I had a successful VBAC after c-section because of failure to progress. Things went so quickly that I ended-up at a different hospital than originally planned. I worked with a midwife at Methodist, but got pain relief via epidural nonetheless, thankfully. Afterwards, I could hardly walk, could not sit without a doughnut for weeks, and I found out later that got an episiotomy that will have to be fixed eventually. The worst part of my experience the first time around was a sense of increasing loss of control and inability to make decisions on my behalf or know what was going on. The second time around, things were out of control in the beginning because of the swift progress of labor and the mind-numbing levels of pain, but became more and more manageable as a I made my wishes known and had them respected during the process.
I think that in hindsight that factor was more important than anything else. After the first time, I came away traumatized from the pain and the unpredictability of things. As far as recovery goes, the c- section was less painful and complex than the recovery from VBAC - besides, there was no episiotomy. I am kind of wedded to doing things the recommended way, the best possible way despite the suffering it might cause for me, but if I didn't have that attachment, I would have chosen c-section. The pain of labor and how long it lasted the second time around was just beyond anything I would have ever wanted to go through."


"I haven't had a c-sec but I have several friends who had unnecessary cecs due to "failure to progress"... (btw... If I hadn't had a midwife, my 4 hours of pushing would have been "failure to progress" too)....  BUT... my friends who've had Vbacs (all successful) were members of ICAN... the support really helped. Here's the link:
 Best of luck!"


"I tried for a VBAC and ended up with a repeat-C. However, I'm not sorry I tried! with my first c-section, I had doubts as to whether it had been necessary. I never really experienced labor, nor did I experience going into labor myself. I was induced and had the c-section shortly thereafter. I felt my OB rushed the whole thing. She called it "failure to progress" but it was Saturday morning and she showed up in a tennis outfit, so I was worried she did the surgery just to move her day along. The second time around I used midwives, I took a private VBAC class and had a doula. I read The VBAC Companion, and a lot of VBAC stories online. I felt really prepared. I went into labor on my own and had 22 hours of labor. I was only 5cm dilated and the baby was not descending. The midwife called in an OB at 3AM to do a c-section. I felt I had done everything I could to avoid the surgery and was at peace with it when I found out I'd have to have the surgery anyway. I had been worried I'd be devastated if that happened, especially if I'd gone through many hours of labor. The OB who performed the surgery said the cord was wrapped around the baby's body and that's why she wasn't coming down.
So, I didn't succeed, but I'm not sorry I tried! I needed to do that. The only drawback is that I wasn't wild about the on-call OB who performed the surgery-- if I had planned a C I could have hand-picked my OB. Hope that helps, and good luck with your decision."


"I had a similar problem- was induced ( a week late) and then went through labor and progressed to fully dilated but my son would not come down in the canal far enough and then I had to have a C section. I discussed a VBAC with my dr at the last visit and he said the research shows that when you need to have a section due to that problem (and not breech, etc) that there is such a high chance of having it again (like your dr said). I really feel he's up on the latest research and despite my hopes to do try a VBAC I think I would not opt to try. For me, the recovery was horrible partially due to a long labor and then a major surgery. My dr told me that when you don't go through labor the recovery is so much better (you aren't exhausted)."


"If you like your dr, I would trust their expertise. I was very disappointed to hear this news as well. I watched a great movie called The Business of Being Born by Ricki Lake. It was so eye opening.
Maybe you could consult a midwife who I think would be much more open to a VBAC and discuss the risks/thoughts on it. I may consider this myself when I get pregnant again. Wish I had done
this for #1, maybe would have avoided a section."


"With my first son, I had a similar situation than yours. A long labor, pushed for 3 hours and ended up with a emergency c-section. I did a VBAC and I had a very easy labor and delivery. I still pushed for 1 1/2 hour, but everything went well and it was very easy. My doctor was very supportive and I had a great delivery nurse that helped me during the labor. I hope this helps, good luck."


"My Thoughts on VBACs
I tell people tongue and cheek, "I had a C-section and then a VBAC and I don't recommend either."  I AM very glad that I had my VBAC, and did the whole no drugs route.  Guess I had that need to deliver a baby like a "women in the woods".  So the actual delivery and pushing and being totally awake for everything without drugs part was great. If I would have wanted the drug route, I would have probably gone for a second C-section-- a few of my friends have gone that route with the second c-section and were pleased with their results. Bummer part was that I tore when I pushed and it was a long time before I healed. I also pushed so hard I broke blood vessels in my eyes (that took about a month to heal).  Pushing also loosened up some of my mommy muscles so Kegels have become a routine I didn't have the first time around. Felt like I sat on blender blades. There were other complications unrelated to me (latching problems) so that compounded things.
Also remember that you are older the second time around and that it's going to take you longer to heal from either a 2nd c-section or a VBAC-- that was one thing I didn't consider. So I don't have any definitive "go for it" advice.  I absolutely enjoyed my VBAC Birth Experience with #2. I was bummed that it was a slower healing process than I was expecting with complications that I hadn't thought about related to the pushing/vaginal delivery thing. I figured I would point out that those are a possibility (tho hopefully not a reality for you if you go that route). Good luck and go with your gut.  I find you don't regret it..."


"I had a c-section - after many hours of failed, induced labor - and  then, with my 2nd and 3rd kids, 2 VBACs. I think it's a medical decision and if your obstetrician thinks you should not be overly concerned about uterine rupture, then you should  try to put it out of your mind. I went into my 2nd baby's delivery with a great sense of distrust  about my body's ability to do what it should (in part because of the  VBAC, in part because of other issues that arose around the birth)  and felt so powerful and strong after pushing baby #2 out! A key, for  me, was great coaching. I had a close relationship with a midwife who  basically served as a labor coach for me, even though she wasn't in  charge (I had some risk issues so was under an OB's care). I don't  know that I could have done it without her coaching and counsel. So perhaps hire a doula to serve the same purpose?"


"Have you read Ina May's Guide to Childbirth? She has a section in the book dedicated to VBAC as well as many stories from moms about successful natural, vaginal deliveries, and some of the deliveries are VBAC. I'm pregnant with my first but this book in general has been really helpful to read. I highly recommend it."


"I think the best person to talk to about this is your OB. I had an emergency C with my first and wanted to go VBAC for my second. There are a lot of considerations the MDs take into account before they agree to do one: did you labor with your first? what type of incision? etc. A VBACs ultimate success depends much more on your body and previous birth than over all statistics."


"I had a VBAC with my second. I have mixed feelings about it. While my 'birth experience' with the VBAC was better - I was able to hold my daughter right away, I felt more with it, I was able to get up and go to the bathroom with-in an hour, my recovery from the VBAC was actually worse than from the C-section. An easier recovery was one of the main reasons I wanted a VBACin the first place. One thing I didn't like about the VBAC is that I was so monitored I was essentially trapped in bed, there was no walking around or even sitting in the rocking chair, there were so many wires attached to me, it was even difficult to change position in bed. I opted for an epidural because I felt there was no way I could labor with out one while not being able to move around.
I was never overly concerned with uterine rupture. The risk is so small and having had an emergency c section with my first, I was aware of how amazingly quickly they can get the baby out when they need to."


"I worked with an OB with my first pregnancy and ended up with a c-section: the baby wouldn't come out after hours of pushing and signs of distress/low heart-rate. I worked with hospital-based midwives for my second pregnancy (births 20 months apart), I had a healthy and easy second pregnancy and a wonderful, successful, and swift VBAC. I was scared, and I didn't think I could do it,but it all worked out and was extremely rewarding."


"I had 2 Vbacs and recommend that you give it a try. The recovery was sooo much easier, and it helped restore confidence in my own body. I got epidurals, because for all 3 births I had to be induced. The first time I was 10 days post date, was induced and ended up with a c-section - and when my son came out at 10 1/2 pounds, I was glad he didn't come out the usual way! For my daughters' births I was induced a week or 10 days before my due date, and was able to push them out. As you probably know, when given Pit you def. want an epidural because the contractions are stronger. The epidural got put in too late with my first birth, so it was very difficult for me to hold still long enough to have the needle inserted. When I told the anaesthesiologist that it was the worst part of my whole first birth experience, he made sure to give me the epidural at 4-5 cm with babies 2 and 3, rather than at 6-7 cms.
The main thing is that you and the baby are healthy, of course, no matter which way s/he comes into the world.
That said, I felt like superwoman after the Vbacs! It was a fantastic experience."


"I had a VBAC with my second child. It was at Methodist hospital. I progressed (after the Pitocin) very quickly... so quickly, in fact, that my OB didn't make it back to the hospital in time to deliver my baby! The team there helped me deliver the baby (the epidural wore off and I was convinced that I would NOT be able to deliver the baby vaginally). They said, after the fact, that they had the cart ready to whisk me away for a C-section should it have came to that. I was very happy that it worked out the way it did. And for the record, when I told my OB initially that I wanted to try for the VBAC, without blinking an eye she said no problem. The feeling that I had was try for the VBAC but be prepared for another c-section. Good luck!!"


"From what I've read, surgery is always more risky than natural childbirth. I haven't picked a midwife yet, but I spoke to a smart one yesterday and she said that unless you have health conditions that make it prohibitive for your body to go into labor, there's no reason a VBAC shouldn't be attempted. I do sometimes wonder whether one recovery is easier than the other. While some people come out of vaginal birth seemingly unscathed, I also have friends who have needed physical therapy for pelvic floor issues, etc. But not being able to walk or sit up after (c-section) was no fun."


"I struggled with the same questions before having a successful VBAC. What I deducted from the research is that a VBAC poses a slightly higher risk to the baby than having a planned c-section. While a repeat c-section poses a higher risk to the mother over a VABC. The risks in either case are extremely small, especially if you give birth in a NYC hospital. All of the statistics include women giving birth in small town hospitals with crappy care, without anesthesiologists on-site, etc. For a VBAC, there is an OB and an anesthesiologist nearby waiting to intervene if necessary (possible? :-).
With a c-section, a dr can say that s/he did all they could to protect a woman and baby from harm. With any vaginal delivery, VBAC or not, a dr is more vulnerable to a lawsuit, no?
Every doctor that I told I had a VBAC congratulated me with sincerity, including my children's pediatrician and my internist.
And my midwife was amazing... I never would have been able to do it without her confidence. It also helped that I had 2 friend who also had successful vbac's before me.
I know that it is a really difficult decision... I wish you luck in whatever you decide."

"I tried for a vbac and ended up with a c- section.
That said, I'm really glad that I tried and I progressed to 7 centimeters which was way beyond the first time!
My second child was wedged in and facing the wrong way so he couldn't slide down. It is my understanding that letting the child be born when s/he is ready and going thru labor are very beneficial to the baby's development and mother's process as well. My recovery the second time around was quick, smooth. And breast feeding was also a breeze the second time. The first time I struggled with both. Do what feels right to you!
Take care!"


"We just had a vbac 4 weeks ago. Our main reason for one was recovery time (couldnt figure out how to bed bound with a 3 year old) and I didn't want the 3 year old to resent the new baby who made mommy bed bound. Knowing what I do now I would also say it is amazing to get the hormones after a vaginal birth which I don't feel I got with the csection (I was up and showering and eating almost immediately too which was so wonderful)
We had a great experience with a doc that specializes in vbacs. Main thing was no early labor at home so they could monitor the old wound for uterine rupture and the baby and if there was an issue you were already at the hospital. I heard a lot of conflicting stuff myself around 2 months before labor too, and just talked them through with my doctor. While not common, there is some very real danger - but by being monitored at hospital we felt we mitigated that risk.
Good luck. Whatever you choose there is a baby on the other end and either option is just fine."


"i just had a vbac in november. i had my first via c-section after 19 hrs labor, but in 2005, so a long time between the two, which i think helps (i think the risk of rupture etc decreases with time). i had my first in sf, and i had the vbac here in brooklyn, at methodist hopsital, with the help of the park slope midwives. the recovery post vbac was ridiculously easy compared to that of the c-section. tho with my c-section, as with yours, i labored first, and i would guess that the recovery following a planned c-section is probably less horrible (in my experience) than a labor first c-section."


"Here are some places to get evidence based information on VBAC...
Henci Goer is a wonderful writer/researcher/advocate who has written a lot about birth and evidence based care. Her 2 books are titled The Thinking Woman's Guide to a Better Birth & Obstetric  Myths Versus Research Realities. Here are some articles she has written about VBAC...
Vaginal birth after cesarean: The facts,,bgjt,00.html
Is vaginal birth after cesarean risky?,,9rft,00.html
Rebuttal to Rationales for Denial of VBAC
VBAC safety: A closer look at the 2002 JAMA study,,j9gw,00.html
This is a great book for anyone considering VBAC...  VBAC Companion – Diana Korte
The International Cesarean Awareness Network (ICAN) is another great resource.  They have lots of information and also have support groups for women to get together and talk about their experiences.
This is their VBAC page...
This is a link to their position papers on many topics including VBAC..."


And some more advice from a June 2020 thread...

Original Poster:


"Did anyone on this thread have a successful VBAC and was glad they tried when being warned to go the other way?
I am having a ton of literature thrown at me about why i should schedule a planned C section, which doesn't fill me with excitement because we don't have any help if the recovery is difficult. My gut tells me to be skeptical of a C.

Some of my considerations:
Will the recovery be worse for a second C section or for a vaginal birth with tearing? I’ve seen two sets of opinions on this. What would the reason be for second C being easier on recovery? I can’t imagine this.
—Is just me or are NYC doctors mostly C-section obsessed? Why is this? In Europe it isn't this way at all. Is it really for the health of the baby or is it because it's easier for them to plan and safer because there's less uncertainty?
--VBAC would be much better for our family than C, considering no childcare or family help for our toddler on the other side of baby 2.0 entering the world. Is this the right assumption?
--Birthing at Mt Sinai East with a high risk practice (MFM). If there would be one place in the birth to risk an attempted VBAC, surely this would be the place?
--I had a 10-days-late post partum haemorrage and had 2 blood transfusions and a D&C and was in hospital for a second set of 5 days after my firstborn. How much should this factor into my decision? Will the second be just like the first and so I need to take rupture risk seriously?
--the NOT knowing. presumably i could switch from an intended VBAC to a C section if the risk got too great at any time. Isn't that right? Like if they have to induce me and we start with a foley balloon and move to pitocin, then presumably if the induction starts to fail, i can switch plans at any time?
--risk of uterine rupture. apparently 1-2% of cases rupture and baby can get into distress and it can lead to brain damage and death. Doc is being very clear that the risk is more to the baby and not to me.
--my height. apparently being on the shorter side (5.2ft) and given my previous C section, my chances of a successful VBAC are coming out at 47%. Are the numbers normally higher?
--do they just open up the existing scar? it took me forever to get some sort of core muscle ability back and i still have a pouch
--what can i be reading to help me ease into a VBAC and sign the scary 'you have been warned of the risks' forms? I won't have a doula and my husband will probably be looking after our toddler for the beginning of labor, so if anyone has any helpful exercises or hints, let me know."

Full Replies:


"It depends on your specific case and your practitioner. I was with PS Midwives for all my 3 pregnancies, who try for vaginal delivery whenever possible and still ended up with 3 c/s (3rd one was no choice). 
With my second kid he was facing 'sunny side up' which I forget what it means, but remember that it's something that makes first time vaginal delivery harder and on top of that there were the prior c/s concerns. They gave me a fair chance, but when we were very close to pushing and they realized which way his face was turned, it became a c/s.
Another friend of mine, also with the first being delivered via c/s, did have an successful vbac with PSM.
Recovery in general is easier with a regular delivery, but of course there could be other potential complications."


"I just had a VBAC at Mt Sinai East on April 21. Shlansky delivered the baby ( My December 2017 labor went so haywire that I was planning a C section but I went into labor a few days before the C section and when I got to Mt. Sinai East Dr. Shlansky (and some other staff there) advised a VBAC because the contractions and everything were going so well. I got an epidural and it did in fact all go well. We had one moment during labor when we thought we might have to go to a C section and Shlansky said if the baby's heartbeat went nuts again we'd go to C section but luckily it was smooth sailing after that.
I thought the recovery was much easier for the VBAC which I was grateful for given our toddler, our 3 story walk up, and the whole pandemic thing and lack of help. I just had my 6 week follow up and everything was great. Shlansky did mention that sometimes women have bladder problems after the VBAC, but I've been fine. I definitely felt more myself sooner after the VBAC. (Hemorrhoids were my main complaint.)
I did find that some of the doctors at MFM seem to be a little more pro C section than others, but I thought Shlansky was really good. If you haven't had an appointment with her maybe schedule one and get her take?"


"Hi, I did not have a successful VBAC, but here's a data point:
- 2 weeks late with first child. foley balloon, pitocin, stalled at 5 cm after 12 hours. non-emergency C, turns out she was sunny side up and wouldn't tuck her chin.
- doc recommended VBAC for second (he's not a C section guy, but I hear you that many in NYC are).
- around 5 days late, swept membranes. went into labor roughly 30 hours later. after about 2 hours of labor, I chose C section because of so much pain/vomiting. baby was 9 lbs, and I would not have been able to get him out vaginally (due to my size), so it would have been same result but maybe emergency at that point.
- he cut into the same scar, and as for healing, it's the same as it was before, meaning the scar is not bigger or thicker. def have a pouch, but also haven't tried in earnest to get rid of it.
- my recovery was fine, but huge asterisk here is that at the start of my 3rd tri, I had a very large, impassable kidney stone block my urethra. because I couldn't get surgery while pregnant, I had a nephrostomy tube placed in my back to bypass the stone and I carried a nephrostomy bag for the last 3 months. this is why I was eager to sweep membranes, and it probably played a factor in my decision to bypass labor and get the baby out--which ended up being good. my kidney was infected, and after birth it went septic. so first week of C section recovery was spent in the hospital... def not a normal recovery, but at the time, the C section seemed like a very minor detail in the whole episode.
- after two Cs, I'm told I can no longer try for a VBAC bc of uterine tearing so that's that. at first, I was upset that I never had a natural birth and it was off the table for future, but now I know that all births are natural. I made a baby in my body from scratch and got it out safe and healthy.
- while we went over my options, my doc explained it as lowest risk successful VBAC, then planned second C, then highest risk failed VBAC. I don't have a study to point to unfortunately, but I thought that was interesting."


"Congrats on #2! I had a successful VBAC in September, with the full support of my doctor (I gave birth at NY Presbyterian Columbia Doctors). I did not have any significant risks or other complicating factors. Ultimately, my focus a healthy baby and a healthy momma, regardless of how that transpired.
For me, the recovery for a vaginal was MUCH easier than from my c-section, but every woman and every birth is different - I was fortunate and had minimal tearing.
All throughout pregnancy and even up to the point of pushing, my doctor asked if I wanted to go ahead with vaginal and reassured me that I could change my mind at any time."


"I’ve had 3 C sections (the first emergency, then two elective) so can’t comment personally on a successful VBAC, however, I would say that my recovery from the planned sections were a lot easier than the emergency one, even with toddler/s to manage. Perhaps part of that was that I knew what to expect, but after my second I was out and about at a street party after 4 days!
I was tempted to try for a VBAC for my second child. I was living in London then and the midwives were very keen to push for this, but the VBAC consultant I saw was much more cautious. In the end I had gestational diabetes and wasn’t allowed to go past my due date and so I opted for an elective section as I had been told that the success rate for VBACs goes down significantly if induction is involved. I decided I would rather a planned section than try for a VBAC, have something go wrong and end up with an emergency one. With my third child, delivered at Mt Sinai, I went straight for section. I found the after care so good that it really gave me a good chance to rest and heal before coming home.
Another thing to consider is how many kids you plan to have. There was A LOT of chat about scar tissue when I was on operating table this time.