From the Guidelines
For most women with one prior low transverse cesarean delivery, attempting a vaginal birth after cesarean (VBAC) is a reasonable option with a lower risk of death and other complications compared to elective repeat cesarean section. When deciding between attempting VBAC versus scheduling an elective repeat cesarean section, it's essential to understand the risks of each option. The main risk of attempting VBAC is uterine rupture, which occurs in approximately 0.5-1% of cases and can lead to emergency cesarean delivery with potential complications for both mother and baby [ 1 ]. Failed VBAC requiring an unplanned cesarean carries higher risks than either successful VBAC or planned cesarean, including increased infection rates, blood loss, and longer recovery time.
Key Considerations
- Elective repeat cesarean section eliminates the risk of uterine rupture but comes with its own risks, including surgical complications, longer recovery, respiratory issues for the baby, and complications in future pregnancies due to multiple cesarean scars [ 1 ].
- Women who have had a previous vaginal birth have a high probability of VBAC, and physicians should encourage these women to plan for VBAC unless specific contraindications exist [ 1 ].
- Perinatal mortality is increased with VBAC compared to repeat cesarean delivery, but the overall risk of death is lower for mothers who undergo VBAC [ 1 ].
Decision Making
The decision between attempting VBAC and scheduling an elective repeat cesarean section should be individualized based on factors that influence VBAC success, such as:
- Prior vaginal delivery
- Reason for previous cesarean
- Maternal age
- BMI
- Estimated fetal weight Discussing these factors with your healthcare provider can help determine which option better aligns with your specific situation and preferences [ 1 ].
From the Research
Risks of Failing VBAC and Going to C-Section vs Elective C-Section
- The risk of uterine rupture is a significant concern for women attempting vaginal birth after cesarean (VBAC) delivery, with a frequency of 0.63% as reported in a study published in 2025 2.
- Induction of labor is associated with an increased risk of uterine rupture, with an adjusted odds ratio (aOR) of 2.2, as found in the same study 2.
- A previous vaginal delivery is inversely associated with the risk of uterine rupture, with an aOR of 0.3, according to the 2025 study 2.
- The use of oxytocin augmentation is also associated with an increased risk of uterine rupture, with an aOR of 2.2, as reported in the 2025 study 2.
- Higher maximum doses of oxytocin are associated with an increased risk of uterine rupture, with a hazard ratio (HR) of 3.92 or greater for doses above 20 mU/min, as found in a 2008 study 3.
- A dose-response relationship between maximum oxytocin dose and uterine rupture exists, with a uterine rupture rate of 2.07% at the highest dosages, as reported in a 2007 study 4.
- However, another study published in 2011 found that labor induction did not appear to increase the risk of uterine rupture in women attempting VBAC, with a uterine rupture rate of 1.0% versus 1.2% for spontaneous and induced labor, respectively 5.
- Planned VBAC compared to elective repeat cesarean section (ERCS) is associated with an increased risk of serious birth-related complications, but the absolute risk is small, as reported in a 2022 review 6.
- The review also found that planned VBAC is associated with benefits such as a shorter length of hospital stay and a higher likelihood of breastfeeding, and that the planned mode of birth after previous cesarean section is not associated with the child's subsequent risk of experiencing adverse neurodevelopmental or health problems in childhood 6.