If you’ve had a prior Cesarean section (C-section) and are pregnant, you may be thinking about how you want to deliver your baby this time around. Your health, your baby’s health, risk factors with your pregnancy and your personal preferences all play into the discussion with your health care provider.

Exploring your options
You need to consider what your provider and the facility where you will give birth are willing to do. First, find out if your doctor or midwife can support your trying to have a vaginal birth after cesarean (VBAC). Fewer facilities in the US are opting to do VBACs, which means you may be limited by your birthing location or your provider. You may find that only facilities that can do emergency deliveries may consider your request for a VBAC. Medical liability concern is another reason VBAC rates in the US are declining.
Despite the trend, there are excellent reasons to consider birthing your baby vaginally even if you’ve had a prior C-section. In March, an expert panel at the National Institutes of Health determined that VBACs are successful for 75% of women who attempt them and that a vaginal trial of labor, even if it ends in a C-section, is associated with a lower risk of death in laboring women. The panel urged the health care system and providers to provide greater access to this option.

Planning a VBAC
If VBAC is an option, talk with your care provider about any risks you may have that will affect whether you should attempt VBAC or plan a cesarean birth. It may come down to choosing from among a list of “pro’s” and “con’s” for each method for you and your baby.
If you’ve already given birth both vaginally and by C-section then your chances of a successful VBAC are higher. If you had a planned C-section with your first baby without going into labor, for example if your baby was in a breech position, then you have the same chances of birthing vaginally this time as a first-time mom. Even if you had a C-section because you were in labor that stalled, remember that in your current pregnancy your baby’s head size and position, and the flexibility of your pelvis, may make it easier to give birth vaginally this time.

If you go into labor on your own, you may also have a better chance of birthing vaginally this time than if your first labor was induced.
Finally, personal preferences are a big part of this decision. If you want to have more children after this one, you may opt for a VBAC because with each additional C-section you have an increased risk for complications in future pregnancies. Or you may want to try for a VBAC so that your family can be more involved in the birth, to have an easier and faster recovery, to be able to bond and breastfeed right away, or because you feel giving birth vaginally is empowering.
On the other hand, you may choose to have a planned repeat C-section so it can be scheduled, in order to have a tubal ligation at the time of the C-section or to avoid the pain of labor. Regardless of your choice, know that the birthing method that results in a healthy outcome for both mom and baby is the best choice for you.