Vaginal Birth After C-Section - When Is It Safe?

Cesarean sections have become increasingly common, with c-section rates soaring all over the world in recent decades. A whopping 32 percent of all births are cesareans in the United States today — a figure that's remained more or less unchanged between 2012 and 2022. That is good news in a sense, because c-sections can be life-saving for mothers and babies alike — but sometimes, they're performed when they are not strictly medically necessary, as doctors err on the side of caution to save lives.

That's often the case, for instance, in mothers who have already had a c-section with a previous baby. When they are pregnant again, many OBGYNs will recommend a repeat cesarean without any second thoughts, and most mothers will accept this suggestion without question. In some circumstances you can, however, opt for a "VBAC" — a vaginal birth after a c-section.

First-time mothers have a similar c-section rate to those who already had a child or more. Did you have a cesarean? If you are planning another baby, you may wonder if “once a c-section, always a c-section” is still the going rule. 

What Happened To “Once A C-section, Always A C-section”? 

Have you heard that moms who gave birth by c-section once are stuck with all c-sections for all subsequent births? Whether it was a friend or a doctor telling you this, you may wonder what's up with all the contradictory information that floats around when it comes to how to handle childbirth after you had a c-section in the past. Here is a brief history of the cesarean section to explain it.  

Plenty of people have heard the story that Julius Caesar was the first to be born by c-section, and that the name “cesarean section” or Caesar's cut actually came from him. The story is almost certainly not true, but cesarean sections were indeed around in Roman times. Julius Caesar's mother became his advisor later on in life. Roman mothers who actually had the ancient equivalent of the c-section were less lucky.  

C-sections in the Roman Empire started out as a means to cut babies out of dead mothers. Later on, Roman physicians also performed “the cut” to save babies who were still in the womb after the mom had entered the tenth month of pregnancy. There are no known cases of Roman mothers surviving cesarean sections.  

The first “modern” cesarean section was carried out by German gynecologist Ferdinand Adolf Kehrer. They have continuously evolved since then. Classical incisions, where the cut is made vertically, were popular only decades ago. Now, a low horizontal incision is most common. This “bikini cut”, coupled with more sturdy double suturing styles, has made vaginal births after cesarean section (VBAC) much safer for mothers and babies.  

Once a c-section, always a c-section? That depends on the reasons for which a woman had a c-section, and on the type of cut used during the last c-section. The guidelines set forth by the American College of Gynecologists and Obstetricians (ACOG) probably describes the rules best: “Most women with a history of one or two uncomplicated low transverse caesarean sections, in an otherwise uncomplicated pregnancy at term and with no contraindications to vaginal birth, are candidates for and should be counseled about VBAC.”  

In other words, if you had a cesarean at term due to circumstances like a breech baby, twins, fetal distress, or other factors that are unlikely to repeat in the next pregnancy, you are very likely a good candidate for a VBAC, or vaginal birth after c-section — if you had a low transverse incision (bikini cut) and are now enjoying a low-risk pregnancy.