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| |    Chances for a Successful VBAC by Marjorie Greenfield, M.D. reviewed by Laura Jana, M.D., F.A.A.P. Many women would choose vaginal birth after cesarean (VBAC) if they could be assured that this effort would not end again in cesarean. The chance for vaginal birth after cesarean depends on many different factors. Reason for prior cesarean Many indications for a cesarean delivery are unlikely to repeat themselves. If your last cesarean was done because your baby was in a breech position and your new baby is headfirst, for instance, you are probably no more likely to need a cesarean than anyone having her first baby (15-35 percent). Even in situations that appear likely to repeat, though, such as the baby not fitting through the birth canal last time, 50-66 percent of mothers will be able to deliver vaginally in the next labor. Prior vaginal birth Women who have had vaginal births before their cesarean are very likely to be able to have vaginal birth after. They have demonstrated that their pelvises are wide enough to permit a baby to pass through, and they-as well as their healthcare providers-are likely to be confident that they can give birth vaginally again. Philosophy of your practitioner It is well known that different practitioners have different rates of cesarean section. A practitioner who supports the decision for VBAC and has a low cesarean rate will be more likely to help you achieve a vaginal birth than one who believes that your choice is unwise or elects cesarean birth rather liberally. Maternal age Women over 40 are somewhat more likely to need cesarean than are younger women, although many older moms still can deliver vaginally if they try. A favorable cervix at the onset of labor A cervix that already has started to dilate or efface at the onset of labor correlates somewhat with successful vaginal birth. Need for induction of labor Induction of labor in itself somewhat increases the chance that the VBAC attempt will not go well and a cesarean will be necessary. In addition, uterine rupture occurs more often in situations where the mother receives Pitocin or prostaglandins, such as misoprostol (Cytotec) or Cervidil, for induction of labor. If other factors look hopeful, however, a woman who requires induction of labor may still try for VBAC. As you can see, some of these factors cannot be assessed until close to your due date, or even after labor has begun. Therefore, it is often helpful to keep an open mind until close to your due date before you and your practitioner decide on a mode of birth.
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