Last updated March 14, 2022

Planning for Labor and Vaginal Birth After Cesarean

RECOMMENDATIONS

Labor after cesarean is safe and appropriate for most women with a history of one or two prior cesarean births. The AAFP recommends that clinicians counsel, encourage and facilitate planned vaginal birth after cesarean so that women can make informed decisions. (, M )
If planned vaginal birth after cesarean is not locally available, then women desiring it should be offered referral to a facility and/or clinician who can offer the service.
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The AAFP strongly recommends that clinicians inform women who have had a prior vaginal birth, either before or after a prior cesarean birth, that they have a high likelihood of vaginal birth after cesarean. Unless there are specific contraindications to a vaginal birth, these women should be encouraged to plan a labor and vaginal birth after cesarean and should be offered referral to clinicians and facilities capable of providing this service, if it is not available locally.
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There are few data about factors other than prior vaginal birth that strongly influence the rate of vaginal birth after cesarean. Clinicians should discuss the indications for and circumstances surrounding a woman’s prior cesarean birth(s) during counseling.
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When a woman who has had a prior cesarean birth presents to the hospital in labor, the clinician caring for her should reassess with her the plan for labor and vaginal birth after cesarean or repeat cesarean, considering factors on admission that may affect the risks of labor and the likelihood of vaginal birth. The clinician should discuss, on an ongoing basis during labor, any change of status affecting the risks of labor and likelihood of vaginal birth for a woman electing labor after cesarean.
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The AAFP recommends that induction of labor after cesarean is appropriate for women who have a medical indication for induction of labor and who are planning a vaginal birth after cesarean. The risk of uterine rupture varies by method of induction. Misoprostol should not be used for cervical preparation or induction of labor after cesarean in the third trimester of pregnancy for women with a prior cesarean birth.
(Quality of Evidence: Low to Moderate)
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Clinicians should inform each woman about the specific short-term benefits and harms of planned labor and vaginal birth after cesarean and planned repeat cesarean birth, both for herself and her fetus/infant. (, )
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Maternal outcomes are equivalent or better with American Academy of Family Physicians | Clinical Practice Guideline Planning for Labor and Vaginal Birth After Cesarean | page 9 LAC/VBAC compared with RCD, (, )
(Quality of evidence varies by outcome)
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while perinatal mortality is increased with LAC/VBAC compared to RCD. (, M )
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Clinicians should inform each woman about the specific long-term benefits and harms of planned labor and vaginal birth after cesarean and planned repeat cesarean birth, and individualize care based on patient preferences regarding lifetime plans for childbearing.

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Compared with vaginal birth after cesarean, a repeat cesarean delivery increases future risks of abnormal placentation,
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hysterectomy (, )
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and surgical complications. (, )
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Limited data show similar outcomes for women undergoing LAC/VBAC regardless of type or location of hospital or birth volume.
However, infants delivered longer than 30 minutes after a decision to perform immediate delivery for possible uterine rupture have poorer longterm outcomes compared with those delivered more quickly. (, )
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All women desiring LAC/VBAC should be counseled about the capabilities of their specific delivery setting, and women determined to be at high risk for complications with either labor and vaginal birth after cesarean or repeat cesarean birth should be referred to facilities capable of effectively treating problems as they develop.
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Hospitals should have institutional guidelines to promote access to labor and vaginal birth after cesarean. Hospitals should actively monitor and endeavor to continuously improve the quality of care for women who choose labor after cesarean.
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Recommendation Grading

Overview

Title

Planning for Labor and Vaginal Birth After Cesarean

Authoring Organization

Publication Month/Year

August 1, 2015

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

The primary purpose is to provide evidence on short- and long-term health outcomes associated with labor and vaginal birth after cesarean delivery. This information can help clinicians and women understand the benefits and risks of labor after cesarean (LAC) and vaginal birth after cesarean (VBAC) compared to a repeat cesarean delivery (RCD) as well as the factors that may influence the chance of a VBAC.

Target Patient Population

Pregnant women

Inclusion Criteria

Female, Adolescent, Adult

Health Care Settings

Ambulatory, Hospital, Operating and recovery room, Outpatient

Scope

Counseling, Assessment and screening, Management

Diseases/Conditions (MeSH)

D016064 - Vaginal Birth after Cesarean, D002585 - Cesarean Section, D017604 - Cesarean Section, Repeat

Keywords

pregnancy, Pregnancy care, cesarean delivery, viginal birth