About 14% of women with a prior cesarean delivery go on to have a vaginal birth with a subsequent pregnancy, based on 2021 CDC data. That number has been climbing slowly, up from 13.9% in 2020. But that overall rate tells only part of the story. Among women who actually attempt a vaginal birth after cesarean (called a trial of labor, or TOLAC), the success rate is far higher, typically between 60% and 80%.
The gap between those two numbers reveals something important: most women with a prior cesarean never attempt a vaginal delivery at all. They schedule a repeat cesarean instead. Whether that’s by choice, medical necessity, or because their hospital doesn’t offer the option varies widely.
Overall Success Rates for TOLAC
The 60% to 80% success range is a broad average. Where you fall within it depends heavily on your individual circumstances. Some of the strongest predictors of success have nothing to do with medical risk and everything to do with obstetric history.
If you’ve had a vaginal delivery at any point, either before or after your cesarean, your odds improve substantially. Women with a prior vaginal birth have roughly 1.8 times the odds of a successful VBAC compared to those who’ve never delivered vaginally. If you’ve already had a successful VBAC in the past, the odds climb even higher, with success rates exceeding 90% in some cases.
On the other end of the spectrum, success rates drop below 60% for women whose original cesarean was performed for a reason likely to recur (such as a pelvis-baby size mismatch), women with a BMI over 30, and those carrying a larger-than-average baby.
Spontaneous Labor vs. Induction
How labor begins makes a meaningful difference. Women who go into labor on their own have notably better outcomes than those who are induced. In one large retrospective study, about two-thirds of women who started labor spontaneously achieved a vaginal birth, compared to half of those whose labor was induced. Induction was also associated with higher rates of cesarean delivery due to fetal distress.
This doesn’t mean induction rules out a successful VBAC. A 50% success rate still means half of induced women deliver vaginally. But if you’re weighing your options and labor hasn’t started yet, it’s worth understanding that spontaneous labor gives you a statistical edge.
The Risk of Uterine Rupture
Uterine rupture is the primary safety concern with TOLAC, and it’s the reason the conversation around VBAC involves careful planning. For women with one prior low-transverse cesarean incision (the most common type), the rupture rate is approximately 5 per 1,000 labors. That translates to about a 0.5% chance. The range in large analyses falls between 2 and 9 per 1,000, with the higher end more likely when labor is induced with medications like oxytocin, where rates can reach roughly 1.1%.
For context, the rupture rate in women with no prior cesarean is dramatically lower, around 0.007%. So a scarred uterus does carry meaningfully more risk, but the absolute numbers remain small. The risk of scar-related complications is the reason most guidelines recommend that TOLAC take place at a facility equipped to perform an emergency cesarean quickly if needed.
VBAC After Two Cesareans
Attempting a vaginal birth after two prior cesareans has traditionally been discouraged, but the data is more reassuring than many people expect. Research comparing outcomes between women with one versus two prior cesareans found no significant difference in success rates (75% vs. 70%) or in uterine rupture rates (0.7% vs. 1.6%). Hysterectomy rates were similarly low in both groups.
These numbers aren’t negligible, and a second scar does add some incremental risk. But the blanket assumption that two cesareans automatically require a third isn’t supported by the evidence.
How VBAC Compares to Repeat Cesarean
The tradeoffs between attempting labor and scheduling a repeat cesarean aren’t as one-sided as they might seem. A successful VBAC generally means a shorter recovery, lower infection risk, and fewer complications in future pregnancies. A failed TOLAC that ends in an unplanned cesarean, though, tends to carry more risk than a planned repeat cesarean because the surgery happens after hours of labor rather than under controlled conditions.
One finding worth noting: maternal mortality is significantly lower with VBAC than with elective repeat cesarean, at 0.38 versus 1.34 per 10,000 deliveries. On the newborn side, babies born via TOLAC are slightly more likely to have a low Apgar score at five minutes (a quick measure of a newborn’s condition), but this doesn’t translate into higher rates of NICU admission. The rates of NICU stays are essentially the same whether you deliver vaginally after a cesarean or have a planned repeat surgery.
What Influences Your Individual Odds
Prediction tools exist to help estimate your personal likelihood of success. The most widely referenced one, developed by the Maternal-Fetal Medicine Units Network, factors in your age, height, weight, BMI, gestational age at admission, cervical dilation and effacement, whether you’ve had a previous VBAC, whether your prior cesarean was for failure to progress, and whether you have a hypertensive disorder. These variables are combined to generate a percentage estimate of success.
The American College of Obstetricians and Gynecologists is clear that a calculator score alone should not be used as a barrier to attempting labor. Some patients and providers find the tool helpful for framing the conversation, while others prefer a broader discussion of risks, benefits, and personal goals. ACOG has also raised concerns about earlier versions of the calculator that included race as a variable, noting that racial differences in outcomes reflect systemic inequity rather than biology, and that using race in the calculation could inappropriately discourage some patients from attempting VBAC.
The factors most consistently linked to higher success include having gone into labor spontaneously, having a cervix that’s already dilating at admission (3 cm or more), having had a previous vaginal delivery, and having had prenatal care throughout the pregnancy. The factors most consistently linked to lower success are a recurring indication for the original cesarean, higher body weight, and an unfavorable cervix at admission.
Why the VBAC Rate Stays Relatively Low
If 60% to 80% of attempts succeed, the obvious question is why only 14% of women with prior cesareans end up with a vaginal birth. Several forces push the number down. Many hospitals, particularly smaller or rural ones, don’t offer TOLAC because they can’t guarantee the immediate surgical backup required. Some providers are reluctant to support it due to liability concerns. And some women, after weighing the uncertainty of labor against the predictability of a scheduled surgery, simply prefer a repeat cesarean.
There’s also a compounding effect: each additional cesarean makes future cesareans more likely, and the U.S. cesarean rate (hovering around 32%) ensures a large and growing pool of women facing this decision with each subsequent pregnancy. The slight upward trend in VBAC rates over recent years suggests the conversation is shifting, but structural barriers at the hospital and insurance level continue to limit access for many women who might otherwise be good candidates.