Weighing the Pros and Cons of Planned VBAC and Repeat Cesarean Section

By Allison Shorten

This article is part of A Woman's Guide to VBAC: Navigating the NIH Consensus Recommendations, a collection of resources that address the most common and pressing questions women may have about their birth choices. View all sections in the guide, including a link to the authors, on the index page.

The decision to plan a vaginal birth after cesarean (VBAC) or a repeat cesarean section (RCS) is a very individual one. There are different risks and benefits for mothers and babies. It is important to weighthese risks and benefits while taking into account each woman's unique values, needs, expectations,past experiences, and desired level of involvement in this decision-making process.

The following summary table compares the various risks and benefits of planned VBAC and planned repeat cesarean section. This is a list of complications that are often talked about when women are thinking about planned VBAC or planned RCS. In a group of 100,000 women who plan a VBAC, there will be some who experience problems. If those same 100,000 women all planned repeat cesarean surgery, there would also be some who experience problems. There is no certain way to predict what the birth will be like no matter which option is chosen. That is why it is important to think about all of the things that are important to you in making any healthcare decision.

For many of the complications listed, the number of women who experience them during VBAC or RCS is still relatively small in number. It is always important to discuss any questions or concerns about options for birth with a trusted pregnancy care provider who can provide more detailed information and meet your individual decision making needs.

Information in these tables has been collated from the Final Statement of the National Institutes of Health (NIH) Consensus Conference on VBAC held in Washington on March 12, 2010. The other main source of information is the evidence-based report that informed the NIH conference panel (Guise et al 2010). The following list of resources may also be helpful to you if you need further information.

Additional Reading

• Nurse Midwives, Clinical Bulletin: Vaginal Birth After Cesarean Section, Number 8, October 2003. http://www.midwife.org/memberFiles/education/Clinical_Bulletin_8.pdf
• www.childbirthconnection.org
• Grobman WA, Lai Y, Landon MB et al. Development of a nomogram for prediction of vaginal birthafter cesarean delivery. Obstet Gynecol. 2007;109(4): 806-812.
• Guise J-M, Eden K, Emeis C, Denman MA, Marshall N, Fu R, Janik R, Nygren P, Walker M,McDonagh M. Vaginal Birth After Cesarean: New Insights. Evidence Report/Technology Assessment No.191. (Prepared by the Oregon Health & Science University Evidence-based Practice Center under Contract No. 290-2007-10057-I). AHRQ Publication No. 10-E001. Rockville, MD: Agency forHealthcare Research and Quality. March 2010.http://www.ahrq.gov/downloads/pub/evidence/pdf/vbacup/vbacup.pdf
• King Edward Memorial Hospital, Vaginal Birth After Caesarean. http://www.kemh.health.wa.gov.au/health/VBAC/index.htm
• National Institutes of Health Consensus Development Conference: Vaginal Birth after Cesarean,New Insights, March 8-10, 2010. http://consensus.nih.gov/2010/images/vbac/vbac_statement.pdf Summary by Allison Shorten March 30 2010.
• Northern New England Perinatal Quality Improvement Network, VBAC Project. http://www.nnepqin.org/ViewPage?id=3
• The Women's: The Royal Women's Hospital, Victoria Australia. VBAC Intrapartum Management. http://www.thewomens.org.au/VBACVaginalBirthafterCaesareanIntrapartumManagement