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-Care provider perception and tolerance of risk
-Care provider preference
-Patient perception of safety
-How informed consent is given
-Location and number of births per year at hospital
-Hospital policy regarding VBAC
-Health insurance status
-Professional association guidelines
These non-medical factors often have the greatest impact on whether or not you are considered a good candidate and in fact give birth vaginally. Before or during labor, non-medical factors are often used to persuade a woman she is not a good candidate, even if she does fit many of the medical criteria for VBAC.
In addition to considering who is likely to have a vaginal birth, looking at uterine rupture risk also plays a part in identifying candidacy for a VBAC.
-A past vaginal delivery
-Allowing for spontaneous labor
-A low transverse uterine scar type
-18 months or longer between pregnancies
-A woman in a healthy weight range
-A hospital that has a medium to high number of births each year
Avoiding induction is a key component in preventing uterine rupture and achieving successful VBAC.
There is no way to be certain whether or not someone will have a successful VBAC. The NIH Statement could not define the ideal candidate for VBAC because all the evidence is based on large groups of women and should not be used to predict an individual’s chance of successful VBAC.
Based on the evidence, the NIH Statement concluded that a planned VBAC is a reasonable option for many pregnant women with one prior low transverse uterine incision. Vaginal birth after multiple Cesareans (VBAmC) and other special situations were not addressed in this consensus statement, but there is some evidence, albeit weaker quality evidence, that shows VBAC in these situations may be a safe choice for most women as well.
To maximize your chances of a successful VBAC, it is vital that you are assessed individually and not compared to a large group of women. To the best of your ability, use a care provider willing to partner with you, and choose a birth setting that offers individualized care. Ultimately your desire for a VBAC and your care provider’s desire to support you fully weigh heavily on your chance of success.
*The available evidence stated is only for planned VBACs taking place in hospitals and does not include out of hospital VBACs.
Lamaze International, www.lamaze.org,