Symbolic representation of healing and new beginnings after a C-section, focusing on VBAC.

VBAC After C-Section: Is It Right for You? Risks, Benefits, and Expert Insights

Jordan Keane in Health & Wellness November 2025 • 4 min read.

"Considering a vaginal birth after cesarean (VBAC)? Understand the specific risks and surveillance needed to make an informed decision for you and your baby's health."

The landscape of childbirth has evolved significantly over the years. One notable trend is the increasing rate of cesarean sections (C-sections). In France, for example, C-section rates climbed from 15.5% in 1995 to 20.8% in 2010. This rise has led to a parallel increase in the prevalence of scarred uteruses, now accounting for approximately 11% of all pregnancies and 19% of those in women who have previously given birth.

When a woman with a scarred uterus becomes pregnant, the question of how to deliver the baby arises. There are generally two options: a planned repeat C-section (PRCS) or a trial of labor after cesarean (TOLAC), with the goal of achieving a vaginal birth after cesarean (VBAC). This article focuses on the latter, providing an in-depth look at the risks and necessary monitoring involved in TOLAC/VBAC.

Deciding between a repeat C-section and attempting a VBAC is a complex decision that should be made in consultation with your healthcare provider. The choice depends on various factors, including your individual risk of uterine rupture and the likelihood of a successful VBAC. Though VBAC is a viable option, it's essential to understand what it entails.

Specific Risks During a Trial of Labor After Cesarean (TOLAC)

Symbolic representation of healing and new beginnings after a C-section, focusing on VBAC.

A scarred uterus carries inherent risks, increasing the potential for obstetric complications in subsequent pregnancies. The more C-sections a woman has had, the higher the risk. When considering a VBAC, these risks need to be carefully weighed against the potential benefits.

The risks associated with TOLAC stem from two primary sources. First, there's the possibility of needing an unplanned C-section if the TOLAC is unsuccessful (occurs in approximately 25% of cases). Second, complications can arise during labor, such as uterine rupture or issues related to placental abnormalities. Despite these risks, the rate of successful VBAC in France has remained relatively stable at around 36% for the past 15 years.

Here are some key considerations regarding the specific risks:

Uterine Rupture: A rare but serious complication where the uterus tears.
Placental Issues: Abnormal placental implantation, such as placenta accreta, can occur.
Emergency C-Section: The need for an unplanned C-section during labor.
Maternal Morbidity: Increased risk of complications, especially with multiple prior C-sections.

A C-section performed on a scarred uterus, whether as an emergency during labor or as a planned procedure (PRCS), carries a higher risk of complications than a C-section on a uterus without previous scarring. This risk is further elevated with repeated C-sections. The most common complications include post-operative adhesions and placental abnormalities, like placenta previa or accreta.

Making an Informed Decision

Deciding whether or not to attempt a VBAC is a deeply personal choice. By understanding the risks and benefits, engaging in open communication with your healthcare provider, and carefully considering your individual circumstances, you can make the decision that is right for you and your baby. Remember, the goal is a safe and healthy delivery, regardless of the path you choose.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/b978-2-294-74722-9.00014-7, Alternate LINK

Title: Particularités De La Surveillance Du Travail Sur Utérus Cicatriciel

Journal: Surveillance Fœtale Pendant le Travail

Publisher: Elsevier

Authors: A. Sartor, O. Parant

Published: 2016-01-01

Everything You Need To Know

What is a Trial of Labor After Cesarean (TOLAC) and how does it relate to a Vaginal Birth After Cesarean (VBAC)?

A Trial of Labor After Cesarean (TOLAC) is an attempt to deliver vaginally after a previous cesarean section. If successful, the vaginal birth is referred to as a Vaginal Birth After Cesarean (VBAC). It involves laboring with the goal of achieving a vaginal delivery instead of undergoing a planned repeat C-section.

What are the specific risks associated with attempting a Trial of Labor After Cesarean (TOLAC)?

The primary risks during a TOLAC include the potential need for an unplanned C-section, uterine rupture (a rare but serious complication where the uterus tears), and placental issues such as placenta accreta. Additionally, there is an increased risk of maternal morbidity, especially with multiple prior C-sections. It's crucial to understand that a C-section performed on a scarred uterus carries a higher risk of complications than one on a uterus without previous scarring, with common complications including post-operative adhesions and placental abnormalities.

How should one decide between a planned repeat C-section (PRCS) and attempting a VBAC?

The decision between a planned repeat C-section (PRCS) and attempting a VBAC via TOLAC should be made in consultation with a healthcare provider. Factors influencing the decision include individual risk of uterine rupture, likelihood of a successful VBAC, and the number of prior C-sections. While VBAC is a viable option for many, it's essential to weigh the risks and benefits carefully.

What is the typical success rate of VBAC, and what factors might influence this?

The rate of successful VBAC in France has remained relatively stable at around 36% for the past 15 years. However, the success of TOLAC depends on various factors, including the reasons for the previous C-section, the number of prior cesarean deliveries, and individual patient characteristics. While a 36% success rate provides a general benchmark, individual success rates can vary.

What are the potential benefits of a successful VBAC, and how do they weigh against the risks associated with TOLAC?

While the risks associated with TOLAC, such as uterine rupture and placental issues, are significant, it's also important to consider the potential benefits of a successful VBAC. These benefits can include avoiding surgery, shorter recovery time, and potentially fewer complications in future pregnancies compared to repeat C-sections. The choice between TOLAC/VBAC and a planned repeat C-section should be a collaborative decision between the patient and their healthcare provider, based on a thorough assessment of individual risks and benefits.