VBAC vs. repeat C-section

How do the options compare?

The lens is a clinician's: guideline endorsement, pregnancy evidence, dosing, onset, and tolerability. Cost and formulation notes appear where relevant.

• ACOG defines TOLAC as an attempt at vaginal birth after cesarean: success results in VBAC, while an unsuccessful attempt requires cesarean birth. A successful VBAC avoids abdominal surgery and is associated with shorter recovery, less blood loss, and lower infection risk. 1
• ACOG reports overall VBAC rates of 60% to 80% among people attempting TOLAC and cautions that prediction estimates are less accurate at lower probabilities. A calculator should support conversation, not block access to TOLAC. 2
• NICHD describes a low-transverse uterine incision as a common favorable feature and lists faster recovery plus lower hemorrhage and infection risk as benefits of successful VBAC. It also emphasizes referral to a facility able to support VBAC when medically appropriate. 3
• A prospective observational study at 19 academic centers compared 17,898 TOLAC attempts with 15,801 elective repeat cesareans. Symptomatic uterine rupture occurred in 0.7% of TOLAC attempts; endometritis and transfusion were also more frequent, while hysterectomy and maternal death did not differ significantly. Nonrandom group selection limits causal comparison. 4
• A systematic review found prior cesarean birth associated with higher placenta accreta odds in the next pregnancy and reported increasing absolute accreta risk with more cesareans. The underlying cohorts were observational, so estimates vary with placenta location and other risk factors. 5

Which option makes sense?

The comparison above is intentionally evidence-first, not brand-first. Please consult your healthcare provider to translate it into a plan that fits your pregnancy specifics.

Disclosure: Pregnancy Smart is a supplement maker. The options compared above sit outside our own product line; this page describes their pregnancy evidence on its own merits.