What's the VBAC success rate?

According to ACOG, about 60 to 80 percent of people who attempt a VBAC deliver vaginally. Your individual success rate depends on factors like the reason for your prior C-section, whether you have had a previous vaginal birth, and how your labor progresses.

Is VBAC safer than a repeat C-section?

Both VBAC and repeat C-section are reasonable choices per ACOG guidelines. VBAC avoids surgical risks like infection, hemorrhage, and longer recovery but carries a small risk of uterine rupture. Repeat C-section avoids rupture risk but carries surgical risks and increases risks in future pregnancies. The right choice depends on what matters most to you.

Can I be induced during a VBAC?

It depends on your provider and hospital. ACOG says induction may be considered during a TOLAC, but certain medications like Cytotec (misoprostol) are generally not recommended because they increase rupture risk. Mechanical methods like a Foley bulb may be an option. Ask your provider what methods they use for VBAC inductions.

What are the signs of uterine rupture?

Signs include abnormal fetal heart rate patterns, loss of station of the baby's head, severe abdominal pain, and vaginal bleeding. Because these signs can develop quickly, your care team monitors you continuously during a TOLAC. If rupture is suspected, an emergency C-section is performed immediately.

Can I have a VBAC after two C-sections?

Yes, a VBA2C (VBAC after two C-sections) is possible, but evidence is more limited and the uterine rupture risk is slightly higher compared to VBAC after one C-section. You need a provider experienced with VBA2C and a hospital equipped for immediate C-section. Discuss your specific scar type and health history with your provider.

Does my hospital allow VBACs?

Not all hospitals offer VBAC. ACOG recommends that hospitals offering VBAC have the ability to perform an emergency C-section immediately available. Some smaller or rural hospitals do not meet this standard and may not permit TOLAC. Call your hospital's labor and delivery unit directly to ask about their VBAC policy.

VBAC Birth Plan for Your TOLAC

What Does VBAC Mean?

VBAC stands for Vaginal Birth After Cesarean. It means attempting a vaginal delivery when you have had a previous C-section. You might also see the term TOLAC, which stands for Trial of Labor After Cesarean. TOLAC is the attempt itself, while VBAC is the successful outcome. When you write a VBAC birth plan, you are planning for a TOLAC, with the goal of a VBAC.

This is different from a standard birth plan template because your medical history includes a uterine scar. That scar shapes monitoring requirements, pain management conversations, and hospital policies in ways that other birth plans do not need to address. A VBAC birth plan gives you space to state your preferences within that framework.

Why a VBAC Birth Plan Is Different

A VBAC birth plan covers the same kinds of preferences as any birth plan, like who you want in the room and how you want to manage contractions. But it also addresses topics that only come up with a prior C-section.

Continuous Electronic Fetal Monitoring

Most hospitals require continuous fetal monitoring during a TOLAC. This means you will likely have monitors strapped to your belly throughout labor rather than intermittent checks with a handheld Doppler. Some hospitals offer wireless telemetry monitors that let you move around, walk, and use the birth ball while still being monitored. Others require wired monitors that keep you closer to the bed. Your VBAC birth plan should state whether you prefer wireless monitoring and whether you want to be informed about any concerning readings before interventions are suggested.

Provider Philosophy

Not every provider is enthusiastic about VBAC. Some are fully supportive, while others may subtly steer you toward a repeat C-section. A doula who understands your birth goals can help you notice when your preferences are being dismissed. Your birth plan should clearly state your commitment to a TOLAC so your entire care team understands your intentions.

Hospital Policy

Not all hospitals permit VBACs. ACOG guidelines recommend that hospitals offering VBAC should have the ability to perform an emergency C-section with staff immediately available. Smaller or rural hospitals that cannot meet this requirement may not allow TOLAC at all. Knowing your hospital's policy before you write your plan saves you from building expectations around a setting that will not support them.

The Risk Conversation

You have probably heard plenty about uterine rupture by now. Yes, it is a real risk, and your plan should acknowledge it by outlining your emergency preferences. But the overall rupture risk for someone with a low-transverse scar is less than one percent, and about 60 to 80 percent of people who attempt a VBAC deliver vaginally, according to ACOG. Your birth plan should reflect informed confidence, not fear.

Key Sections to Include in Your VBAC Birth Plan

Here are the sections that matter most when you are planning a VBAC. Some overlap with any birth plan, and others are VBAC-specific.

Provider Support and Prior Birth History

Start by stating your commitment to a TOLAC. Include the reason for your previous C-section and note whether it was a one-time circumstance, like a breech baby, or something that might repeat, like failure to progress. This helps your team understand your individual situation.

Example language for your plan:

I am committed to a Trial of Labor After Cesarean. My prior C-section was due to [reason]. I believe my body is capable of a vaginal birth and I request that my team support my TOLAC effort unless a true medical concern arises.

Monitoring Preferences

Since continuous monitoring is likely required, your preferences should focus on how you want that monitoring to happen, not whether it happens. Ask for wireless or telemetry monitors so you can stay mobile. Request that your nurse share monitoring information with you at regular intervals rather than only when there is a concern. If you want to labor in water, ask whether waterproof telemetry is available.

Pain Management

Some providers recommend an early epidural during a TOLAC so that anesthesia is already in place if an emergency C-section becomes necessary. Others support unmedicated birth with the understanding that anesthesia can be administered quickly if needed. There is no single right answer here, and your doula can help you think through what feels right.

Your birth plan should state your preference while also including flexibility language. For example:

I hope to labor without an epidural for as long as possible. I am open to one if I request it or if my care team recommends it for my safety or the baby's well-being.

If you are planning an induced labor, check out our induction birth plan template for additional considerations specific to medically started labor.

Induction and Augmentation Policy

Induction during a TOLAC is a nuanced topic. ACOG says induction may be considered, but certain medications carry higher rupture risk. Cytotec (misoprostol) is generally not recommended for VBAC inductions. Mechanical methods like a Foley bulb may be an option. If your provider uses Pitocin to augment a slow labor, your plan should state whether you are comfortable with that and under what conditions.

Write this section clearly so your team understands your boundaries:

I am open to induction with a Foley bulb or membrane stripping if medically indicated.
I do not consent to the use of Cytotec (misoprostol) due to increased rupture risk.
I would like to discuss any Pitocin augmentation before it is started.

Emergency C-Section Preferences

This section is about what happens if your TOLAC becomes a C-section. It might feel scary to write, and that is completely normal. Having a plan for the unexpected does not mean you expect it to happen. It means you are prepared and your voice is heard no matter how your birth unfolds.

Include these preferences:

Clear drape: Ask for a clear or lowered drape so you can see your baby being born if you want to.
Partner present: State that you want your partner or support person with you in the OR.
Skin-to-skin if stable: Request that your baby be placed on your chest as soon as medically safe, or that your partner hold the baby skin-to-skin if you are not yet able to.
Delayed cord clamping: If you want delayed clamping and the team can safely do it, include that preference.
Breastfeeding support: Ask for lactation support as soon as you are in recovery.

If you want more ideas for what to include in a surgical birth scenario, our C-section birth plan guide covers this in more detail.

Finding a VBAC-Friendly Provider

Your birth plan only works if your provider supports it. Finding the right care team is one of the most important steps in preparing for a VBAC.

Questions to Ask a Potential Provider

How many VBACs do you attend each year?
What is your personal VBAC success rate?
Under what circumstances would you recommend switching from a TOLAC to a repeat C-section?
Do you support spontaneous labor over scheduled repeat C-section?
What induction methods do you use for VBAC patients?
Is wireless monitoring available at the hospital where you deliver?

Red Flags to Watch For

A provider might say they are VBAC-friendly but their actions tell a different story. Watch for these warning signs:

They say they support VBAC but schedule a repeat C-section "just in case" at 39 weeks.
They dismiss your questions or rush through the risk conversation.
They use fear-based language about rupture without giving you the full picture, including the 60 to 80 percent VBAC success rate.
They are not willing to review or discuss your birth plan with you.

If you are seeing these red flags, it may be time to find a doula and consider switching providers. You deserve a team that genuinely supports your goals.

ACOG Guidelines and Your Rights

ACOG's practice bulletin on VBAC states that most people with one prior low-transverse C-section are candidates for a TOLAC. They also note that attempting a VBAC is a reasonable choice for many people with two prior C-sections, those with an unknown scar type, and those carrying twins. You have the right to attempt a TOLAC even if your provider would prefer a repeat C-section. You also have the right to refuse surgery. Knowing the facts about your options empowers you to make decisions from a place of confidence, not pressure.

Cost Considerations for a VBAC

A VBAC is typically less expensive than a repeat C-section because it avoids the costs of surgery, a longer hospital stay, and a longer recovery period. However, insurance coverage varies, and some plans may have different requirements for VBAC versus repeat C-section. Understanding your doula cost and insurance considerations ahead of time helps you plan without surprises. A postpartum doula can also be especially helpful after a VBAC, whether your recovery is smooth or more complex than expected.

Your Next Step

You do not have to build your VBAC birth plan from scratch. The Joyful Birth Plan walks you through every section with prompts designed for moms who want to birth with intention. It includes VBAC-specific sections so you can address monitoring, induction preferences, and emergency protocols without missing anything.

Download the Joyful Birth Plan, fill in your preferences, and bring it to your next prenatal appointment. Your voice matters in that room, and a clear plan makes sure it is heard.

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How to Write a VBAC Birth Plan That Supports Your Birth Goals