Clinical Practice Guideline

Vaginal Birth After Cesarean

(Developed by the AAFP, May 2014) (Reaffirmed 2019)

The guideline, Labor After Cesarean/Planned Vaginal Birth After Cesarean, was developed by the American Academy of Family Physicians. It was approved by the Board of Directors in 2014 and an executive summary was published in the Annals of Family Medicine on January 12, 2015.

Key Recommendations

Counseling, encouragement and facilitation for a planned vaginal birth after cesarean (PVBAC) should be provided so that women can make informed decisions. If PVBAC is not locally available, then women desiring it should be offered referral to a facility or clinician who can offer the service.

Indications for and circumstances surrounding the prior cesarean birth(s) should be discussed.

Induction of labor after cesarean is appropriate for women who have a medical indication for induction of labor and who are planning a LAC/VBAC. Misoprostol should not be used for cervical preparation or induction of labor in the third trimester of pregnancy for women with a prior cesarean birth.

At time of labor and presentation to the hospital, the plan for labor and vaginal birth should be reassessed with consideration of factors on admission that may affect the risks of labor and likelihood of vaginal birth. Any changes in status during labor should be discussed.

Patients should be informed of the specific short-term and long-term benefits and harms of planned LAC/VBAC for the patient, her fetus/infant, and future pregnancies.

All women desiring planned LAC/VBAC should be counseled about the capabilities of their specific delivery setting and women at high risk for complications should be referred as necessary to facilities with capabilities to effectively treat problems as they develop.

Hospitals should have guidelines to promote access to LAC/VBAC and actively monitor and improve quality of care for women who choose labor after cesarean.

Read the full recommendation for further details.

More About Practice Guidelines

These recommendations are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute for the individual judgment brought to each clinical situation by the patient's family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These recommendations are only one element in the complex process of improving the health of America. To be effective, the recommendations must be implemented.