Pregnant woman on VBAC journey toward sunrise.

VBAC Success: How to Navigate Labor After a C-Section

Beau Callahan in Health & Wellness December 2025 • 4 min read.

"A comprehensive guide to understanding labor progression, epidural use, and strategies for a successful vaginal birth after cesarean (VBAC)."

Deciding on the best course of action for childbirth after a Cesarean section (C-section) can feel overwhelming. Many women face the choice between another C-section and attempting a Vaginal Birth After Cesarean (VBAC). Understanding the factors that contribute to a successful VBAC is essential for making an informed decision that aligns with your health and preferences.

For years, medical professionals have studied the labor curves of women undergoing VBAC to better understand the process and improve outcomes. These studies analyze various elements, including the length of labor stages and the impact of pain management techniques such as epidural analgesia. By examining these patterns, healthcare providers can provide more personalized care and support to women attempting VBAC.

This article delves into the key findings from recent research on VBAC, offering practical insights into what to expect during labor, how epidurals may influence the process, and when medical intervention might be necessary. Empower yourself with knowledge to navigate your VBAC journey with confidence.

Understanding VBAC Labor: What Does the Research Show?

Pregnant woman on VBAC journey toward sunrise.

A recent study published in Archives of Gynecology and Obstetrics explored labor progression in women attempting VBAC, with and without epidural analgesia. The study retrospectively analyzed 781 TOLAC (Trial of Labor After Cesarean) deliveries, dividing the women into two groups: those undergoing TOLAC with no prior vaginal delivery and those with at least one previous vaginal delivery and current TOLAC. The goal was to assess how labor patterns differ between these groups and how epidural use affects those patterns.

The research revealed several key differences:

Labor Duration: Women attempting TOLAC with no prior vaginal delivery experienced significantly longer labors compared to those with a previous vaginal delivery.
Epidural Impact: In both groups, epidural analgesia was associated with longer first and second stages of labor.
VBAC Success: Interestingly, in the TOLAC-only group, more women who had epidural analgesia tended to deliver vaginally compared to those who did not, though this finding was not statistically significant (P=0.09).
Second Stage Duration: For women who delivered vaginally, the 95th percentile for the second stage duration with epidural was 3.4 hours in the TOLAC-only group and 2.3 hours in the previous VD and TOLAC group. Without epidural, the 95th percentile was 1.4 hours and 0.9 hours, respectively.

These findings underscore the importance of considering individual factors, such as prior vaginal deliveries and epidural use, when managing labor in women attempting VBAC. The data suggests that normal labor curves may differ significantly in these populations.

Making Informed Decisions for Your VBAC Journey

Attempting a VBAC requires careful consideration and a collaborative approach between you and your healthcare provider. Understanding how labor patterns may differ based on your individual history and choices, such as epidural use, is crucial. The study suggests that operative intervention (instrumental delivery or C-section) might be considered after a 2-hour second stage without epidural, or 3 hours with epidural, potentially reduced by an hour for women with prior vaginal deliveries. By staying informed and discussing your options with your medical team, you can make confident choices that support a safe and positive birth experience.

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: 10.1007/s00404-018-4956-5, Alternate LINK

Title: Labor Progression Of Women Attempting Vaginal Birth After Previous Cesarean Delivery With Or Without Epidural Analgesia

Subject: Obstetrics and Gynecology

Journal: Archives of Gynecology and Obstetrics

Publisher: Springer Science and Business Media LLC

Authors: Netanella Miller, Michel Pelleg, Nasrean Hag-Yahia, Yair Daykan, Yael Pasternak, Tal Biron-Shental

Published: 2018-11-01

Everything You Need To Know

What are the main benefits of understanding labor patterns and epidural use in VBAC?

Understanding labor patterns and the impact of epidural analgesia in VBAC empowers women to make informed decisions about their birth experience. Knowledge of labor progression and pain management techniques allows for a collaborative approach with healthcare providers, potentially leading to a safer and more positive vaginal birth after cesarean. Understanding these elements enables personalized care, aligning choices with individual health and preferences, and improves overall outcomes during the VBAC journey.

How does a previous vaginal delivery impact the labor process for women attempting a Trial of Labor After Cesarean (TOLAC)?

Women attempting TOLAC with a prior vaginal delivery typically experience shorter labors compared to those without. Research indicates that labor duration is significantly reduced in individuals with a history of vaginal birth. This difference in labor patterns highlights the importance of considering a woman's obstetric history when managing labor after a previous cesarean.

How does epidural analgesia affect the duration of labor stages in women undergoing TOLAC, and what are the implications for VBAC success?

Epidural analgesia is associated with longer first and second stages of labor in women undergoing TOLAC. However, it's interesting to note that in women attempting TOLAC with no prior vaginal delivery, epidural analgesia was associated with a higher rate of vaginal delivery. This nuanced effect suggests that while epidurals may prolong labor, they can still contribute to VBAC success in certain populations. The second stage duration with epidural was 3.4 hours in the TOLAC-only group and 2.3 hours in the previous VD and TOLAC group. Without epidural, the 95th percentile was 1.4 hours and 0.9 hours, respectively. Individual factors and preferences should be carefully considered when deciding on pain management strategies during labor.

When might medical intervention, such as instrumental delivery or C-section, be considered during a Trial of Labor After Cesarean (TOLAC)?

Operative intervention might be considered after a 2-hour second stage without epidural, or 3 hours with epidural, potentially reduced by an hour for women with prior vaginal deliveries. This guideline underscores the importance of monitoring labor progression and making timely decisions to ensure the safety of both mother and baby. These timeframes are benchmarks and should be considered within the context of overall labor progress and maternal/fetal well-being.

What key factors should women discuss with their healthcare provider when planning for a Vaginal Birth After Cesarean (VBAC)?

Women planning for a VBAC should discuss their individual obstetric history, including any previous vaginal deliveries and the reasons for the prior cesarean. They should also discuss the potential impact of epidural analgesia on labor progression, understanding that it may lengthen labor but could still contribute to a successful VBAC. Understanding these aspects and having a collaborative discussion helps in creating a birth plan that aligns with their preferences and promotes a safe and positive birth experience. Furthermore, understanding the hospital's VBAC policies and the availability of resources is crucial.