VBAC: having a vaginal birth after a caesarean

If you’ve had a caesarean, you can usually choose between trying for a vaginal birth and having another caesarean. Here are the figures, so you can weigh them up.

The two choices

After a previous caesarean you can plan a vaginal birth (VBAC) or an elective repeat caesarean. The NHS says most women can safely have a vaginal birth next time, possibly with extra monitoring in labour, though some are advised to have another caesarean. The Royal College of Obstetricians and Gynaecologists (RCOG) says the decision is yours, and whichever option you choose should be respected by your healthcare professionals. Tommy’s says your team will usually talk this through soon after your anomaly scan at 18 to 21 weeks, and ideally you’d decide before 36 weeks.

The chance of success

RCOG says 3 out of 4 women who have had one caesarean go on to give birth vaginally if labour starts naturally.
About 8 to 9 out of 10 women who have already had a vaginal birth can have another.
Around 1 in 4 women attempting a VBAC end up with an emergency caesarean, compared with about 1 in 5 for a first birth.

Risks of trying for VBAC

RCOG says the scar may separate or tear (uterine rupture) in up to 1 in 200 women. Up to 1 in 3 of those women may need an emergency hysterectomy. Because of the risk, RCOG says continuous monitoring of your baby’s heartbeat is offered once regular contractions start, and you’ll be advised to give birth in hospital. See baby monitoring in labour.

Risks to your baby

RCOG says the risk of your baby dying because of a planned VBAC is very low, about 4 in 10,000 births, which is about the same as giving birth vaginally for the first time. Serious risks to your baby, which include brain injury or death around the time of birth, are slightly higher with a planned VBAC than with a planned caesarean, by around an extra 10 in 10,000 babies.

Risks of a planned repeat caesarean

RCOG gives the scar rupture risk as less than 1 in 4,000 with a planned repeat caesarean, but it lists other risks. Infection affects 2 to 7 in 100 women. Bladder injury is around 1 in 1,000, and placenta accreta (the placenta growing too deeply into the womb) is around 1 in 1,000, about three times more common after a previous caesarean. Recovery usually takes about 6 weeks. Babies born at 38 weeks are more likely to need neonatal care. See caesarean birth.

Induction and VBAC

RCOG says induction raises the chance of an emergency caesarean and can increase the risk of scar rupture two to three times, depending on how labour is started. It lowers the chance of a straightforward VBAC. See induction of labour.

Who might be advised differently

RCOG says VBAC is not advised after three or more previous caesareans, a previous uterine rupture, a ‘classical’ caesarean (a cut in the upper part of the womb), or other complications that need a planned caesarean. VBAC is less likely to succeed if your BMI is 30 or more at your first antenatal check. Your team will go through your individual situation.

Questions people ask

Can I have a VBAC after two caesareans?

RCOG says women with more than one caesarean are advised on their individual benefits and risks. Ask your consultant what applies to you.

What if my labour needs to be induced?

RCOG says it lowers the chance of a straightforward VBAC and raises the risk of rupture, so your team will talk through the options with you.

Can I have a VBAC at home or in a midwifery unit?

RCOG advises hospital birth for VBAC, with continuous monitoring. Ask your team about local options.

How long should I wait between babies?

Tommy’s says doctors may advise waiting 12 to 18 months before trying again, depending on your health and your last caesarean.