Description/Etiology
The decision to undergo vaginal birth after cesarean delivery (VBAC) is based on evaluating
the predictors of a successful trial of labor and the risk of complications, antenatally, in
labor, and in delivery, and in future pregnancies, against the patient’s preference. The
American College of Obstetricians and Gynecologists (ACOG) advises against VBAC for
women who have had a classical hysterotomy (i.e., a vertical incision that extends above
the insertion of the round ligaments), extensive transfundal uterine surgery, previous uterine
rupture, medical or obstetric complication that precludes vaginal delivery, or two prior
uterine scars and no vaginal deliveries. The guidelines for VBAC issued by ACOG require
the presence of an obstetrician, an anesthesiologist, and/or a staff capable of performing an
emergency cesarean delivery throughout the patient’s active phase of labor for patients who
undergo a trial of labor following cesarean delivery. A failed VBAC that requires emergency
cesarean delivery is associated with greater complications than an elected repeat cesarean
delivery.