Why the Uterine Incision Matters
Transverse (Horizontal) Uterine Incision
Most modern C-sections use a low transverse cut across the thinner part of the uterus. This type generally supports VBAC attempts because the scar is less likely to rupture.
Vertical (Classical) Uterine Incision
A vertical incision cuts through the thicker upper uterine muscle and carries a higher rupture risk. VBAC is usually not recommended in this case.
Skin vs. Uterine Scar
The direction of your skin scar does not always match the uterine incision. Only the uterine incision matters for VBAC safety.
VBAC Candidacy Checklist
- Reason for the previous C-section (e.g., breech position vs. stalled labor)
- Number of prior C-sections and any additional uterine surgeries
- Overall health, pregnancy complications, or high-risk factors
- Hospital policies and whether emergency staff are available for rapid C-section if needed
- How long it’s been since your last birth (closely spaced pregnancies may increase rupture risk)
Only your obstetrician or midwife can determine if VBAC is safe for you. Bring this list to your next appointment to start the conversation.
Factors That Improve VBAC Success
Time Between Births
Spacing pregnancies at least 18–24 months apart gives your uterus added healing time.
- Share your full pregnancy history so your provider can estimate scar strength.
- Ask whether imaging is needed to evaluate your lower uterine segment.
Reason for Previous C-Section
Nonrecurring reasons—like breech presentation—often lead to higher VBAC success.
- Request operative notes to confirm why surgery was required.
- Discuss how likely those circumstances are to happen again.
Labor Onset
Spontaneous labor usually carries lower rupture risk than inductions with strong medications.
- Ask about low-intervention induction methods if you go past your due date.
- Clarify when your provider would recommend moving to a repeat C-section.
Benefits & Risks
Benefits
- Shorter recovery time compared to surgery
- Less postpartum pain and no additional abdominal scar
- Lower risk of surgical complications such as infection or bleeding
- Opportunity for immediate skin-to-skin contact and earlier bonding
Risks
- Uterine rupture (rare but serious) that can lead to emergency C-section
- Possible need for surgical delivery if labor stalls or fetal distress occurs
- Some hospitals may lack resources for urgent intervention, limiting VBAC access
How to Prepare
- Request your previous surgical records to confirm the type of uterine incision.
- Discuss VBAC candidacy with your obstetrician or midwife early in pregnancy.
- Confirm that your hospital or birthing center allows VBACs and has staff to handle emergencies.
- Create a flexible birth plan that includes preferences for both VBAC and repeat C-section scenarios.
- Take childbirth education classes that focus on labor after cesarean to refresh coping strategies.
Hospital Readiness Checklist
Emergency Resources
- OB provider or midwife immediately available
- Anesthesiologist on call for rapid epidural or surgery
- Operating room prepped within minutes if needed
Monitoring & Mobility
- Policy on wireless vs. wired fetal monitoring
- Requirements for IV lines or saline locks
- Access to birth balls, showers, or tubs while on monitors
Support Person Rules
- Doula access and overnight visitor policies
- Whether birth plans are reviewed each shift
- If music, photos, or aromatherapy are allowed
Labor Strategies for VBAC
Stay Mobile
- Use upright positions, hip circles, or lunges to keep baby descending.
- Request intermittent monitoring or telemetry belts when safe.
Fuel Wisely
- Follow hospital rules on light snacks or clear liquids to maintain energy.
- Alternate water with electrolyte drinks to avoid dehydration.
Layer Coping Tools
- Combine breathing patterns with counter-pressure or massage.
- Use heat packs for scar discomfort and cool cloths for nausea.
Monitoring & When to Pivot
Your Body
- Notify staff immediately if scar pain is sharp, constant, or paired with bleeding.
- Ask how often cervical checks will occur so you know what to expect.
Baby’s Signals
- Review fetal heart rate patterns that could prompt intervention.
- Clarify how long you can push before assisted delivery is recommended.
Pivot Preferences
- List which birth-plan elements you’d like to keep if a C-section becomes necessary (music, delayed cord clamping).
- Decide who will accompany baby if you need extra monitoring in the OR or recovery.
Frequently Asked Questions
How likely is a VBAC to succeed?
Success rates vary based on the reason for the first C-section, number of prior surgeries, and current health. Many people with a transverse uterine incision can have a vaginal birth with no complications.
Why is a hospital’s policy important?
Facilities must be prepared for emergency C-sections if complications arise. If your hospital does not support VBAC, you may need to consider another location.
Can I try a VBAC after more than one C-section?
Some providers consider VBAC after multiple cesareans, but risks are higher. Your doctor will evaluate your history carefully.
Does a VBAC hurt less than a repeat C-section?
Pain experiences differ. VBAC avoids abdominal surgery recovery, but labor contractions can be intense. Pain management plans can include epidurals, nitrous oxide, or other coping tools.
What if I change my mind?
Plans can evolve as pregnancy progresses. Talk openly with your care team so they know your wishes and can pivot safely if needed.
Questions for Your Doctor
- What type of uterine incision did I have previously?
- Am I a good candidate for VBAC based on my health history?
- What is your VBAC success rate in patients similar to me?
- Does this hospital have staff available 24/7 for emergency C-sections?
- What are the signs that would prompt switching to a surgical delivery during labor?
Emotional Prep & Support
Educate & Connect
- Join VBAC-focused classes or online communities for evidence-based tips.
- Listen to success stories while remembering every labor is unique.
Communicate Intentions
- Share your “why” with your support team so they can encourage you.
- Identify phrases or affirmations that help you stay calm if plans change.
Plan a Debrief
- Schedule a postpartum visit specifically to discuss how the birth went.
- Journal or talk with a counselor to process emotions, no matter the outcome.
Key Takeaways
Know Your Scar
Request records to confirm your uterine incision type.
Talk Early
Discuss VBAC during prenatal visits to understand candidacy.
Check Policies
Choose a hospital that supports VBAC and emergency readiness.
Stay Flexible
Have a backup plan in case medical reasons require surgery.
Important Medical Disclaimer
This article provides educational information only. It is not a substitute for personalized medical advice, diagnosis, or treatment. Always follow the recommendations of your obstetrician, midwife, and hospital team.
If you experience severe pain, bleeding, or symptoms of labor, contact your healthcare provider immediately or go to the hospital.