When a mother who previously delivered via cesarean section (C-section) chooses to attempt a vaginal delivery for a subsequent pregnancy, this is known as a vaginal birth after cesarean, or VBAC. While VBAC can be a safe option for many women, it carries specific risks—particularly uterine rupture—that require careful medical management and monitoring. When healthcare providers fail to properly evaluate VBAC candidates, recognize warning signs of complications, or perform timely interventions, the results can be devastating: oxygen deprivation, severe brain injuries, and permanent disabilities for newborns.
If your child suffered a brain injury due to complications during a VBAC delivery in New York, understanding your legal rights is the first step toward obtaining justice and compensation for your family.
What Is VBAC?
VBAC stands for vaginal birth after cesarean. It refers to a vaginal delivery by a woman who has had at least one previous cesarean section. When a woman attempts VBAC, this is medically termed a trial of labor after cesarean (TOLAC), regardless of whether the vaginal delivery is ultimately successful.
According to the American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin No. 205, approximately 60% to 80% of women who attempt TOLAC achieve a successful vaginal birth. Success rates increase significantly with each prior VBAC: women with one previous successful VBAC have an 87.6% success rate, and those with two or more prior VBACs have success rates exceeding 90%.
VBAC Success Factors: Women with prior vaginal delivery, spontaneous labor onset, a body mass index (BMI) under 30, and an interbirth interval of 18 months or more have the highest likelihood of VBAC success.
However, VBAC is not appropriate for everyone. ACOG guidelines specify that most pregnant individuals with one previous low-transverse cesarean incision are candidates for TOLAC and should be counseled about this option. Factors such as suspected macrosomia (large baby), twin gestation, maternal obesity, and even two prior low-transverse cesareans are not automatic contraindications to VBAC.
Understanding VBAC Risks and Complications
The primary risk associated with VBAC is uterine rupture—a rare but serious complication where the uterine scar from the previous cesarean tears open during labor. When uterine rupture occurs, it can lead to catastrophic outcomes for both mother and baby.
Uterine Rupture Statistics
Recent research provides updated data on uterine rupture rates:
- A 2024 French multicenter study involving 48,124 patients found a complete uterine rupture frequency of 0.63% (approximately 1 in 159 deliveries) among women attempting VBAC with one prior cesarean.
- In the United States and other high-income countries, uterine rupture rates range from 0.3% to 0.7% for women with one prior low-transverse cesarean section.
- Rupture rates are significantly higher in low-resource settings: 2.1% in sub-Saharan Africa and up to 4.9% in Central Africa.
- Women with a prior classical (vertical) uterine incision face a 12% risk of uterine rupture and should not attempt VBAC.
Risk Factors That Increase Uterine Rupture
Not all VBAC attempts carry the same level of risk. According to recent studies, certain factors significantly increase the likelihood of uterine rupture:
| Risk Factor | Adjusted Odds Ratio (aOR) | Impact |
|---|---|---|
| Induction of labor | 2.2 | 2.2x higher risk |
| Bishop score <6 (unfavorable cervix) | 1.8 | 1.8x higher risk |
| Oxytocin augmentation | 2.2 | 2.2x higher risk |
| Arrest of cervical dilatation (1+ hours) | 1.8 | 1.8x higher risk |
| Prior classical incision | — | 12% rupture rate (contraindication) |
| Prior uterine rupture | — | Absolute contraindication |
Protective Factors That Decrease Risk
Conversely, some factors reduce the risk of uterine rupture:
- Prior vaginal delivery: Women with at least one prior successful vaginal birth have a 70% reduced risk (aOR 0.3) of uterine rupture during VBAC.
- Multiple prior VBACs: Uterine rupture rates decrease with each successful VBAC—from 0.87% for first-time VBAC to 0.45% for second VBAC and 0.38% for third VBAC.
- Spontaneous labor onset: Women who go into labor naturally (without induction) face lower rupture risk than those requiring labor induction.
How Uterine Rupture Causes Brain Injury
When the uterus ruptures during VBAC, two mechanisms can deprive the baby of oxygen:
- Maternal hemorrhage: The mother loses substantial blood volume, reducing blood flow and oxygen delivery to the baby through the placenta.
- Placental separation: The rupture may cause the placenta to detach from the uterine wall (placental abruption), cutting off the baby’s oxygen supply entirely.
Even brief periods of oxygen deprivation can cause hypoxic-ischemic encephalopathy (HIE), a type of brain damage resulting from reduced oxygen and blood flow to the brain. Moderate to severe HIE frequently leads to permanent neurological disabilities, including cerebral palsy, epilepsy, developmental delays, and cognitive impairments.
Critical Time Window: When HIE is diagnosed, babies must receive therapeutic hypothermia (brain cooling) within six hours of birth to prevent cerebral palsy or reduce its severity. Delays in recognizing and treating HIE can worsen outcomes.
When VBAC Goes Wrong: Birth Injuries from Medical Negligence
While uterine rupture is a known risk of VBAC, many catastrophic outcomes are preventable through proper medical care. Birth injuries resulting from VBAC often involve one or more forms of medical negligence:
Common Types of VBAC Brain Injuries
When VBAC complications are mismanaged, babies may suffer:
| Birth Injury | Symptoms & Effects | Long-Term Prognosis |
|---|---|---|
| Hypoxic-Ischemic Encephalopathy (HIE) | Oxygen deprivation to the brain; seizures, poor muscle tone, feeding difficulties, altered consciousness | Mild HIE: possible full recovery. Moderate/severe: high risk of cerebral palsy, epilepsy, intellectual disability |
| Cerebral Palsy | Movement disorders, muscle stiffness or floppiness, difficulty walking, impaired coordination | Permanent; requires lifelong therapy, assistive devices, and potentially 24/7 care |
| Periventricular Leukomalacia (PVL) | White matter brain damage; motor delays, vision problems, learning disabilities | Common cause of spastic diplegia cerebral palsy |
| Seizure Disorders | Recurring seizures beginning in infancy or childhood | May require lifelong anti-seizure medication; can impact development and quality of life |
| Intellectual and Developmental Disabilities | Delayed milestones, learning difficulties, cognitive impairments | Varies from mild to profound; may require special education and support services |
According to Cerebral Palsy Guidance, birth asphyxia (oxygen deprivation during labor and delivery) accounts for approximately 6% to 8% of all cerebral palsy cases. In cases involving VBAC, uterine rupture is a recognized cause of acute profound asphyxia.
Common Medical Errors in VBAC Deliveries
Healthcare providers have specific obligations when managing VBAC deliveries. Failure to meet these standards of care can constitute medical malpractice.
1. Improper Candidate Selection
Not all women are appropriate candidates for VBAC. Medical providers must thoroughly evaluate each patient’s medical history and risk factors before recommending TOLAC. Malpractice occurs when:
- A provider recommends VBAC to a woman with a prior classical (vertical) uterine incision or unknown incision type
- A patient with a history of uterine rupture is counseled to attempt VBAC
- A woman with extensive transfundal uterine surgery is advised to attempt vaginal delivery
- Contraindications to vaginal delivery (such as placenta previa or placenta accreta) are overlooked
2. Failure to Obtain Informed Consent
Patients have the right to understand the risks, benefits, and alternatives before consenting to VBAC. ACOG guidelines emphasize that women should be counseled about TOLAC using shared decision-making tools, including VBAC success calculators.
Malpractice occurs when:
- Providers fail to disclose the risk of uterine rupture (0.3%-0.7% baseline risk)
- Patients are not informed about increased risks associated with labor induction or oxytocin augmentation
- The alternative option of repeat cesarean delivery is not adequately discussed
- Facility limitations are not disclosed (e.g., inability to perform emergency cesarean within 30 minutes)
3. Inadequate Fetal Monitoring
Continuous electronic fetal monitoring is essential during VBAC to detect early signs of uterine rupture or fetal distress. Malpractice occurs when:
- Medical staff fail to perform continuous fetal heart rate monitoring
- Abnormal fetal heart tracings (late decelerations, prolonged bradycardia, loss of variability) are ignored or misinterpreted
- Nursing staff fail to promptly notify the attending physician of concerning changes
- Monitoring equipment malfunctions are not addressed
Warning Signs of Uterine Rupture: Sudden severe abdominal pain, vaginal bleeding, abnormal fetal heart rate patterns (especially prolonged bradycardia), loss of fetal station (baby moves higher in birth canal), and maternal shock symptoms.
4. Delayed Emergency Cesarean Delivery
ACOG guidelines state that TOLAC should be attempted only in facilities equipped to perform emergency cesarean delivery. When uterine rupture or fetal distress occurs, time is critical. Malpractice occurs when:
- Providers delay the decision to perform emergency cesarean despite clear warning signs
- The facility lacks adequate staffing or resources for immediate surgical intervention
- Communication breakdowns delay surgical preparation
- The emergency cesarean is performed more than 30 minutes after recognition of a serious complication
A delayed emergency C-section is one of the most common factors in VBAC birth injury lawsuits. Every minute of delay increases the duration of oxygen deprivation and the severity of resulting brain damage.
5. Failure to Recognize and Treat Uterine Rupture
Even when rupture occurs, prompt recognition and intervention can prevent catastrophic outcomes. Malpractice occurs when:
- Medical staff fail to recognize maternal complaints of severe pain or a “tearing” sensation
- Sudden changes in fetal heart rate are not immediately investigated
- Delays occur in assembling the surgical team
- The newborn does not receive immediate resuscitation and neonatal intensive care
VBAC Eligibility and ACOG Guidelines
The American College of Obstetricians and Gynecologists has established clear guidelines for VBAC eligibility and management. Understanding these standards is essential when evaluating whether medical negligence occurred.
VBAC Candidates (Generally Safe)
According to ACOG Practice Bulletin No. 205, most women with one previous cesarean delivery with a low-transverse incision are safe candidates for TOLAC. The following factors are NOT contraindications:
- Suspected macrosomia (large baby)
- Twin gestation
- Maternal obesity
- Two prior low-transverse cesarean deliveries
- Unknown prior uterine incision type (if no clinical indication of classical incision)
- Induction or augmentation of labor
VBAC Contraindications (Not Safe)
Certain conditions make VBAC unsafe and constitute absolute contraindications:
| Contraindication | Reason |
|---|---|
| Prior classical (vertical) or T-shaped uterine incision | 12% rupture risk; extends into uterine fundus (thick muscular upper portion) |
| Prior uterine rupture | Significantly elevated risk of recurrent rupture |
| Extensive transfundal uterine surgery | Weakened uterine integrity |
| Placenta previa | General contraindication to vaginal delivery |
| Placenta accreta spectrum | Requires planned cesarean with possible hysterectomy |
| Vasa previa | Risk of fetal hemorrhage during vaginal delivery |
Facility Requirements
ACOG emphasizes that TOLAC should be performed only at facilities capable of providing emergency care. Specifically, the facility must:
- Have the capability to perform emergency cesarean delivery for situations that are immediate threats to the life of the woman or fetus
- Maintain adequate staffing (physicians, anesthesiologists, nurses, operating room personnel) immediately available
- Have blood products readily accessible for maternal transfusion if needed
- Provide neonatal resuscitation capabilities
When a facility or provider recommends VBAC without meeting these requirements, this can constitute negligence if complications arise.
New York VBAC Birth Injury Verdicts & Settlements
VBAC birth injury cases resulting in brain damage and cerebral palsy often result in substantial verdicts and settlements. While each case is unique, reviewing past outcomes provides insight into potential compensation.
Notable VBAC and Birth Injury Cases
| Case Location | Year | Verdict/Settlement | Case Details |
|---|---|---|---|
| Tennessee | 2020 | $15,153,488 | Small mother with prior C-section advised to attempt VBAC; baby became stuck in birth canal, suffered brain damage and cerebral palsy |
| Illinois | 2016 | $11,200,000 | 34-year-old mother with two prior C-sections advised to attempt VBAC (Kahnkari v. Pombar) |
| Pennsylvania | 2018 | $7,200,000 | Mother sued doctor and hospital for negligently advising VBAC and failing to be properly prepared (Ziolokowski v. Escobar) |
| New York (Queens) | Recent | $111,700,000 | Child sustained brain damage and cerebral palsy during delivery; one of largest NY birth injury verdicts (Patel v. NYC Health & Hospitals) |
| New York | 2020 | $8,200,000 | Failure to timely perform C-section resulting in hypoxia and severe cerebral palsy |
| New York | 2020 | $5,891,304 | Child suffered HIE during delivery, resulting in spastic cerebral palsy; requires feeding tube, wheelchair, 24/7 care |
| New York | Recent | $5,100,000 | Medical negligence settlement where doctors ignored clear signs of fetal distress |
According to legal industry data, birth injury malpractice cases have the highest potential settlement and verdict values of any personal injury category. The median jury verdict in birth injury cases ranges from $1,750,000 to $2,000,200, with the average approximately 30% higher than other medical malpractice claims.
Important Note: Past verdicts and settlements do not guarantee similar results in future cases. Each case’s value depends on the severity of injury, degree of negligence, available insurance coverage, and strength of evidence.
How to Prove VBAC Medical Malpractice
To establish a successful medical malpractice claim for a VBAC birth injury in New York, your attorney must prove four essential elements:
1. Doctor-Patient Relationship
You must establish that a doctor-patient relationship existed, creating a duty of care. This is typically straightforward—prenatal care records and delivery documentation confirm the relationship.
2. Breach of the Standard of Care
This is the most complex element. Your attorney must prove that the healthcare provider’s actions (or failures to act) fell below the accepted standard of care. In VBAC cases, this often involves demonstrating:
- The provider deviated from ACOG guidelines
- Fetal monitoring was inadequate or abnormal findings were ignored
- The decision to perform emergency cesarean was unreasonably delayed
- The patient was an inappropriate candidate for VBAC but was counseled to attempt it anyway
- Informed consent was not properly obtained
To prove breach of standard of care, your attorney will retain medical expert witnesses—typically obstetricians with VBAC experience—who will review medical records and testify about what a competent provider would have done under the same circumstances.
3. Causation
You must prove that the provider’s negligence directly caused your child’s injuries. This requires establishing:
- The baby was healthy before the negligent act or omission
- The brain injury occurred during or immediately after delivery
- The injury would not have occurred (or would have been less severe) if the provider had acted appropriately
Medical records, fetal monitoring strips, Apgar scores, and neonatal intensive care unit (NICU) records provide crucial evidence of causation.
4. Damages
Finally, you must demonstrate that your child suffered actual harm resulting in quantifiable damages. In VBAC brain injury cases, damages typically include:
- Past and future medical expenses (surgeries, therapies, medications, equipment)
- Costs of long-term or lifelong care and support services
- Pain and suffering experienced by the child
- Loss of quality of life and enjoyment of normal childhood activities
- Parents’ emotional distress and loss of companionship
Compensation Available in VBAC Birth Injury Cases
When medical negligence during VBAC causes permanent brain injury, families face extraordinary financial burdens. Compensation in these cases is designed to address both economic and non-economic damages.
Economic Damages
Economic damages compensate for measurable financial losses:
- Medical expenses: Hospital bills, NICU stays, surgeries, specialist consultations, diagnostic testing, prescription medications
- Rehabilitation costs: Physical therapy, occupational therapy, speech therapy
- Assistive devices and equipment: Wheelchairs, walkers, communication devices, modified vehicles
- Home modifications: Wheelchair ramps, accessible bathrooms, lift systems
- Future medical care: Lifetime medical treatment projected by life care planners
- Special education: Tutoring, specialized schools, educational therapies
- Lost earning capacity: Compensation for the child’s inability to work and earn income as an adult
- Parental lost wages: Income lost by parents who must care for a disabled child
Non-Economic Damages
Non-economic damages address intangible losses:
- Pain and suffering: Physical pain and discomfort experienced by the child
- Emotional distress: Psychological trauma to the child and family
- Loss of quality of life: Inability to participate in normal activities, sports, social events
- Loss of companionship: Impact on parent-child relationships
- Disfigurement or disability: Permanent physical or cognitive impairments
New York does not cap non-economic damages in medical malpractice cases, allowing juries to award compensation commensurate with the severity of harm.
Punitive Damages
In rare cases involving extreme recklessness or intentional misconduct, courts may award punitive damages to punish the wrongdoer and deter similar behavior. These are uncommon in VBAC malpractice cases but may apply if, for example, a facility knowingly allowed VBAC attempts without adequate emergency resources.
Time Limits for Filing a VBAC Birth Injury Lawsuit in New York
New York’s statute of limitations for medical malpractice cases is generally 2.5 years from the date of the negligent act. However, for birth injuries involving minors, special rules apply:
- The statute of limitations is extended: the lawsuit must be filed by the child’s 10th birthday, or within 2.5 years of the malpractice (whichever is later).
- This means if your child suffered a brain injury during a VBAC delivery, you generally have until the child turns 10 to file a lawsuit.
Despite this extended deadline, it’s crucial to consult with an attorney as soon as possible. Medical records can be lost or destroyed, witnesses’ memories fade, and gathering evidence becomes more difficult over time.
Important Deadline: If your claim is against a New York City public hospital (NYC Health + Hospitals), you must file a Notice of Claim within 90 days of the injury. Missing this deadline can bar your case entirely.
Frequently Asked Questions About VBAC Brain Injury Lawsuits
What is the success rate of VBAC?
According to ACOG, approximately 60% to 80% of women who attempt trial of labor after cesarean (TOLAC) achieve a successful vaginal birth. Success rates are higher for women who have had a prior vaginal delivery, go into labor spontaneously, have a BMI under 30, and have an interbirth interval of at least 18 months. Women with multiple prior successful VBACs have success rates exceeding 90%.
What is the risk of uterine rupture during VBAC?
For women with one prior low-transverse cesarean incision, the risk of uterine rupture during VBAC ranges from 0.3% to 0.7% (approximately 1 in 200 to 1 in 300 deliveries). Recent 2024 studies report a rupture rate of 0.63%. Risk increases with labor induction (2.2x), oxytocin augmentation (2.2x), and unfavorable cervix (1.8x). Prior vaginal delivery reduces risk by 70%.
Who should not attempt VBAC?
VBAC is contraindicated for women with: a prior classical (vertical) or T-shaped uterine incision (12% rupture risk), prior uterine rupture, extensive transfundal uterine surgery, placenta previa, placenta accreta spectrum, or any condition that contraindicates vaginal delivery. Women with unknown prior incision types should undergo imaging or operative report review before attempting VBAC.
What are signs of uterine rupture during labor?
Warning signs include: sudden severe abdominal pain or a “tearing” sensation, vaginal bleeding, abnormal fetal heart rate patterns (especially prolonged bradycardia or sudden decelerations), loss of fetal station (baby moving higher in the birth canal), loss of uterine contractions, and maternal symptoms of shock (rapid pulse, low blood pressure, pallor). Any of these signs requires immediate emergency cesarean delivery.
Can a baby survive uterine rupture without brain damage?
Yes, if uterine rupture is recognized immediately and emergency cesarean delivery is performed within minutes. However, uterine rupture often causes sudden severe oxygen deprivation. The baby’s prognosis depends on how quickly the rupture is diagnosed and how fast the baby is delivered. Delays of more than 10-15 minutes can result in hypoxic-ischemic encephalopathy (HIE), cerebral palsy, or death.
What is hypoxic-ischemic encephalopathy (HIE)?
HIE is brain damage caused by oxygen deprivation (hypoxia) and reduced blood flow (ischemia) to the brain. It commonly occurs during labor and delivery due to complications like uterine rupture, placental abruption, or umbilical cord problems. Moderate to severe HIE frequently leads to cerebral palsy, epilepsy, developmental delays, and intellectual disabilities. Babies diagnosed with HIE must receive therapeutic hypothermia (brain cooling) within six hours of birth to minimize brain damage.
How much is a VBAC birth injury case worth?
VBAC brain injury cases involving cerebral palsy or permanent disabilities often result in settlements and verdicts ranging from $2 million to over $100 million, depending on the severity of injury and degree of negligence. Average jury verdicts in birth injury cases range from $1.75 million to $2 million. Factors affecting case value include: lifetime medical costs, need for 24/7 care, loss of earning capacity, strength of liability evidence, and insurance policy limits.
How long do I have to file a VBAC birth injury lawsuit in New York?
For birth injuries to minors, New York law allows you to file a lawsuit until the child’s 10th birthday (or within 2.5 years of the malpractice, whichever is later). However, if your claim is against a New York City public hospital, you must file a Notice of Claim within 90 days of the injury. It’s critical to consult with an attorney immediately, as evidence preservation and expert analysis take time.
What does a VBAC malpractice attorney do?
A VBAC birth injury attorney will: investigate the medical care provided during labor and delivery, obtain and review all medical records and fetal monitoring strips, consult with medical experts to determine if negligence occurred, calculate the full value of your damages (including lifetime care costs), negotiate with insurance companies and defendants, and litigate your case in court if a fair settlement cannot be reached. Most birth injury attorneys work on a contingency fee basis, meaning you pay no attorney fees unless you win.
Can I still file a lawsuit if I signed a consent form for VBAC?
Yes. Signing a consent form does not waive your right to sue for medical malpractice. The consent form only confirms you were informed of risks; it does not excuse negligent care. If your provider failed to properly monitor you and your baby, delayed emergency intervention, or provided substandard care, you can still pursue a malpractice claim regardless of having signed consent forms.
Connect with a Qualified New York VBAC Birth Injury Attorney
If your child suffered a brain injury, cerebral palsy, HIE, or other permanent disability due to complications during a VBAC delivery in New York, you deserve answers and justice. Birth injury cases are complex, requiring in-depth medical knowledge, expert testimony, and extensive resources to prove negligence.
Our network includes experienced New York birth injury attorneys who have successfully represented families in VBAC malpractice cases. These attorneys understand the medical standards for VBAC care, work with leading obstetric experts, and have secured millions of dollars in compensation for children with birth injuries.
Free Case Evaluation: Most birth injury attorneys offer free consultations and work on a contingency fee basis—you pay no attorney fees unless your case is successful. There is no risk in learning about your legal options.
Time is critical. Medical records must be preserved, experts must be consulted, and in some cases, a Notice of Claim must be filed within 90 days. Don’t wait—contact a qualified attorney today to protect your child’s future.
