Q&A: I'm having a difficult time decided whether I should have a VBAC or a C-section.

The decision to have a vaginal birth after Cesarean (VBAC) versus a scheduled repeat Cesarean can be tough. The serious complication of uterine rupture is the biggest worry for some moms, leading them to choose repeat Cesarean. But many women want the experience of vaginal birth. Also, vaginal birth (if you knew that was going to be the outcome of your attempt at VBAC) is safer than Cesarean for mother and Baby. Plus, if you are planning more children after this one, a second VBAC is much safer than a third Cesarean, and a third VBAC is much much safer than a fourth Cesarean. The more Cesareans you have, the more likely you are to experience serious complications.

The most feared complication of attempting VBAC is uterine rupture. In uterine rupture, the old incision in the uterus breaks open, which can lead to oxygen deprivation to the baby, and even death. Moms, too, have died from uterine rupture. Women who had a classical (vertical) incision in the uterus (which may not be the same as the incision on the skin), have a higher risk of uterine rupture, as much as 10 percent, and VBAC is not considered safe. Fortunately, most Cesareans are "low transverse" meaning that the uterine incision is crossways in the lower part of the uterus, and rupture is rare (less than 1 percent). Many uterine ruptures can be managed without injury to the baby, but about one in 10 uterine ruptures has serious consequences for the mother or Baby.

Think of it this way: there are three possibilities, successful VBAC, unsuccessful VBAC followed by Cesarean, and scheduled Cesarean. If you had a crystal ball and knew that you would give birth vaginally, VBAC would be the best option. Unfortunately, no one can guarantee that attempting VBAC this time won't end in Cesarean again. And of the three possibilities, the outcome most likely to have complications is labor and then Cesarean. Cesarean after labor raises the chance of infection and excess blood loss, and is needed in cases of uterine rupture.

So what is a mother to do? Your decision will depend on several factors: how many children you plan to have (because multiple Cesareans have increasing intrinsic risk), whether you go into labor on your own or require induction again (induction has a slightly higher chance of uterine rupture, and a lower chance of successful vaginal birth), and what the circumstances were around the first Cesarean—whether it is something that is likely to repeat. Having had a previous vaginal birth increases the odds for a successful VBAC. Based on what you have told me, the odds are in your favor for a successful vaginal birth. Talk to your doctor or midwife so you can make the decision that is right for you.