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Are you pregnant again following a c-section? In this article, we discuss the risks of vaginal birth after cesarean section, and how they compare to the risks of a repeat c-section to help you decide which option is right for you.

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.

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 Ceasar was the first to be born by c-section, and that the name “cesarean section” or ceasar's cut actually came from him. The story is almost certainly not true, but cesarean sections were indeed around in Roman times. Julius Ceasar'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 horizintal incision is most common. This “bikini cut”, coupled with more sturdy double suturing styles, have 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 cut itself. The guidelines set forth by the American College of Gynecologists and Obstetricians (ACOG) probably describes it 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 are usually good candidates for a VBAC — if they had a low transverse incision and are enjoying a low-risk pregnancy.  

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