One of the most common things I hear from pregnant women after they’ve had a C-section is this:
“I was told a VBAC is too risky.”
As a doula and labor and delivery nurse this absolutely blows my mind. Not because VBAC is risk-free (no birth option is), but because the risk of a VBAC is so often misrepresented, oversimplified, or framed in a way that fuels fear rather than informed decision-making.
If you’re deciding between a VBAC and a repeat C-section, this post will walk you through the actual data, not emotional language or worst-case scenarios, so that you can make a decision from a place of confidence and peace.
What Is a VBAC?
VBAC stands for Vaginal Birth After Cesarean. You may also hear the term TOLAC, which means Trial of Labor After Cesarean. While that’s common medical language, I don’t prefer that term since it subtly implies uncertainty or danger where it often doesn’t belong.
For most women with one prior C-section, there are typically two options:
- A planned repeat C-section
- Attempting a vaginal birth (VBAC)
VBAC has become controversial in many medical settings, despite the fact that over one-third of women in the U.S. now give birth by C-section. With numbers that high, VBAC shouldn’t be rare or discouraged. It should be a normal, evidence-based option.
The Biggest Fear: Uterine Rupture
When people talk about the risk of a VBAC, what they’re usually referring to is uterine rupture. It sounds terrifying, and it is a definitely a serious complication. However, seriousness does not equal likelihood.
According to the American College of Obstetrics and Gynecology (ACOG), the risk of uterine rupture during a VBAC is approximately 0.47-0.7%, or about 5-7 women out of 1,000. To phrase this another way, you have about a 99.5% chance of not experiencing uterine rupture during a VBAC attempt. That number alone surprises most women because providers rarely explain it this way.
How Often Are Outcomes Actually Catastrophic?
A large, high-quality study of roughly 145,000 women attempting VBAC gives us even more clarity.
Out of 100,000 VBAC attempts:
- About 620 women experienced uterine rupture
- About 282 women experienced a severe outcome
- Some required hysterectomy
- Some babies experienced oxygen deprivation
- Maternal death occurred in 2 cases
That means over 99.7% of women did not experience a severe outcome related to VBAC.
These numbers matter, especially when fear-based counseling often suggests VBAC is “extremely dangerous” or “life-threatening.”
Relative Risk vs Absolute Risk
One of the biggest problems in how the risk of a VBAC is communicated is language.
You may hear things like:
- “VBAC doubles your risk”
- “It’s much more dangerous”
- “Your baby could die”
Those are examples of relative risk language, and very emotionally loaded.
Absolute risk sounds very different:
- “Your risk goes from 1 in 100,000 to 2 in 100,000”
Both statements could be technically true, but only one gives you the information you actually need to make a decision. When discussing VBAC (or any birth decision), you should always ask your provider for absolute numbers, not just emotional framing.
Why the Risks of Repeat C-Sections Matter Too
Something that often gets left out of VBAC conversations is that C-sections carry real risks too (especially with each additional surgery).
Compared to vaginal birth, C-sections are associated with higher rates of:
- Hemorrhage
- Infection
- Organ injury
- Blood clots
- Maternal death
- Respiratory complications for babies
The risks of each of these complications increase with every subsequent C-section which is important to consider especially if you desire to have a larger family.
An Overlooked Risk: Placenta Accreta
One of the most serious long-term risks tied to repeat C-sections is placenta accreta, where the placenta grows into the uterine wall due to scar tissue.
This condition is directly correlated with rising C-section rates and becomes more likely with each surgery. It carries a maternal death rate of about 7%.
When comparing the risk of a VBAC to a repeat C-section, especially for women who want larger families, placenta accreta must be part of the conversation.
When VBAC May Not Be Appropriate
Despite the fact that a VBAC is often a safer option, it isn’t right for everyone. Situations where it may not be recommended include:
- A prior classical (vertical) uterine incision (not as common in recent years)
- Multiple previous C-sections (especially 5+)
- Placenta previa
- Transverse fetal position
- Any condition that would make vaginal birth unsafe regardless of C-section history
This is why individualized counseling matters.
Induction and the Risk of a VBAC
One important factor that does increase the risk of a VBAC is induction, especially when pitocin or cervical ripening agents like Cytotec (misoprostl) are used. These medications are known to increase the risk of uterine rupture even in women without prior C-sections.
Final Thoughts
This isn’t about pushing one birth option over another. It’s about ensuring you are the one making the decision — not fear, not pressure, and not incomplete information.
When you understand the real risk of a VBAC and the real risks of repeat C-sections, the conversation changes, and confidence grows where fear once lived. If you are pregnant and planning a VBAC or considering your options, please know of my prayers for you!
