Previous Cesarean Delivery

Almost one-third of all babies born in the United States are delivered by cesarean, or “C-section,” a surgical procedure that uses incisions in the mother’s abdomen and uterus to deliver the baby.

Women who have had a C-section may face increased risks of complications in future pregnancies. The more C-sections a woman has had, the greater the risks.

Potential complications include:

• Problems with the placenta
• Heavy bleeding
• Infection
• Scar tissue (adhesions) that make a C-section more difficult, delaying delivery and increasing the risk of damage to other nearby organs, such as the bladder and bowel
• The risk of uterine rupture or tear along the uterine scar line from previous C-section(s)
• The need for a hysterectomy at delivery (removal of the uterus)

Understand Your Delivery Options

If you are pregnant and have a history of cesarean delivery, it is important to talk to your health care provider about your delivery options, including:

• The risks and benefits of a repeat C-section
• The risk of multiple repeat C-sections
• Whether a vaginal birth after cesarean (VBAC) is an option for you
• The risks and benefits of a VBAC

Are You a Candidate for VBAC?

For many women who have had prior C-sections, a vaginal birth may be an option.

Among the factors to be considered are:

• The type of uterine incision used
• History of previous uterine rupture
• Medical conditions or other pregnancy complications that increase the risk of a vaginal delivery
• The facility where the delivery will take place

According to the American College of Obstetricians and Gynecologists, approximately 60 to 80% of “eligible candidates” who attempt VBAC are successful.

The Benefits of VBAC

The benefits of a VBAC compared to a planned repeat C-section include:

• No abdominal surgery
• Reduced risk of hemorrhage and infection
• Faster recovery and shorter hospital stay
• Fewer complications such as the need for a hysterectomy, bowel and bladder injury, and abnormal placenta conditions
• Increased likelihood of delivering vaginally in future pregnancies (another VBAC)

The Risks of Attempting VBAC

Attempting VBAC is known as a “trial of labor after cesarean.” Risks can include:

• Uterine rupture, which can be harmful to your baby
• Maternal hemorrhage and infection
• Possible need for a hysterectomy

If the attempt to deliver vaginally fails, the woman will require a C-section.

What to Look for in Treatment

In general, treatment for pregnancies involving previous C-sections should include:

• An individualized plan of care based on your pregnancy, medical history and personal preferences
• A carefully planned delivery at an appropriately equipped facility, with the resources and staff required to address any emergencies that arise
• A contingency plan for emergency delivery

Benefits of Specialized Care

Texas Children’s Pavilion for Women offers you and your baby specialized care for these pregnancies and deliveries, including:

• Expert consultation and evaluation to assess your risks and delivery options 
• Close monitoring and careful management to quickly address any issues that arise
• Proven expertise and outcomes in VBACs
• Delivery at a state-of-the-art facility equipped 24/7 to address the needs of mother and baby should complications or emergencies occur during pregnancy or delivery