We discuss the advantages and risks of a vaginal birth after a caesarean and answer questions you might have about vaginal births after caesarean.
What is a VBAC?
A vaginal birth after caesarean (VBAC) is when a woman gives birth vaginally, after having had a caesarean previously. Vaginal birth includes a straightforward vaginal delivery and a birth assisted by forceps or ventouse (RCOG, 2016).
"You might be able to have a VBAC even if you've had more than one previous caesarean."
What are the advantages and risks of having a VBAC?
What are the advantages of a VBAC?
VBAC is an option for most women, and research shows that when a VBAC is successful it has fewer complications than an elective repeat caesarean section (ERCS). Most women are able to have a successful VBAC without any complications (NHS Choices, 2017).
The advantages of a successful vaginal birth are:
- A greater chance of a vaginal birth in future pregnancies.
- Recovery and returning to everyday activities is likely to be quicker.
- Your stay in hospital might be shorter.
- You are more likely to be able to have skin-to-skin contact with your baby immediately after birth, which might help you to establish breastfeeding successfully.
- By having a VBAC you avoid the risks of an operation.
- Your baby will have less chance of initial breathing problems. (RCOG, 2016)
What are the risks of VBAC?
- The risks vary and depend on your obstetric history, the reasons for any previous caesarean(s), and whether you have previously given birth vaginally.
- Risks of VBAC include the scar from the previous caesarean birth opening up (uterine rupture). This affects around one in 200 women trying for a VBAC. That risk is increased two to three fold if labour is induced.
- Not everyone who plans a VBAC will succeed in having one. Out of 100 women attempting a VBAC, 25 will need an emergency caesarean.
- Sometimes opting for a VBAC isn’t advised. For example, if you’ve previously had a uterine rupture, significant uterine stretching or uterine surgery, or have a vertical scar on your uterus or placenta praevia. (RCOG, 2016; NHS Choices, 2017)
Will I need extra monitoring during a VBAC?
If you’re having a VBAC, you will usually be offered extra monitoring during labour (NHS Choices, 2016). This will include the baby’s heartbeat being monitored continuously once you’re having regular contractions (RCOG, 2016). Extra monitoring checks everything is progressing well and detects any early signs of problems with your previous caesarean scar (RCOG, 2016).
Due to the risks, you’ll be advised to give birth in a hospital labour ward with facilities for immediate caesarean and blood transfusion (NICE, 2012).
What if my midwife says I shouldn’t have a VBAC?
If you choose to plan a vaginal birth after previously giving birth by caesarean, your preferences and priorities should be taken into account (NICE, 2012). A woman in the UK who is deemed to have capacity to consent has the right to refuse a caesarean, and this should be respected (NICE, 2012).
Where it is difficult to agree a mutually acceptable solution between you and your healthcare professionals, you might choose to request a second opinion (NHS Choices, 2016b). Depending on your local area, you might be able to request a discussion with a specialist midwife to discuss your birth plan (NICE, 2012).
Can I have a VBAC if I’ve had more than one caesarean birth?
Even if you’ve had up to four previous caesarean sections, there is no difference in the risk of fever or injuries between a VBAC and a planned caesarean. Your risk of risk of uterine rupture is higher but it’s still rare (NICE, 2012).
There is a slightly increased risk of hysterectomy and blood transfusion in women having a VBAC after two previous caesarean births, compared with one previous caesarean birth (RCOG, 2015b). If you’re considering a vaginal birth after more than one caesarean birth, do discuss the potential risks, benefits and success rates with a senior obstetrician (RCOG, 2015b).
It’ll be recommended that you give birth in hospital because you’d have immediate access to caesarean section and on-site blood transfusion facilities if you needed it (North Lincolnshire NHS Trust, 2011; NICE, 2012). You can ask to discuss whether a home birth might be suitable for your particular situation with your midwife and obstetrician (North Lincolnshire NHS Trust, 2011).
How likely am I to have a successful vaginal birth after a caesarean?
Research suggests that the chances of a successful VBAC are:
- 85% to 90% if you have had a previous baby vaginally in the past
- 58% to 75% after one or two previous caesarean births.(RCOG, 2015a; NMPA, 2018)
The success rates for VBAC are lower if you have:
- your labour induced or speeded up
- only ever given birth by caesarean
- a BMI greater than 30 at that start of pregnancy
- previously had a caesarean section because of a difficult labour. (RCOG, 2015a)
If all four of these apply to you, the chance of having a successful VBAC is reduced to 40% (RCOG, 2015a).
Some women find it hard to decide what to plan for or find it very emotional, after having a caesarean birth, especially if it was an emergency caesarean. There is plenty of perinatal support available if you need it.
It’s a good idea to talk through your birth options with your partner. You can also discuss any medical concerns with your midwife, health visitor or GP.
This page was last reviewed in June 2018
Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.
We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.
Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.
NHS Choices has an article that you might find useful, called How do I get a second opinion?
You can look at the statistics for your local hospital on caesarean section rates and VBAC rates on the Which? Website.
NHS Choices. (2016) Caesarean section: overview. Available from: https://www.nhs.uk/conditions/caesarean-section/#future-pregnancies-after-a-caesarean [Last accessed 8 June 2018].
NHS Choices. (2016b) How do I get a second opinion? Available from: https://www.nhs.uk/chq/Pages/910.aspx?CategoryID=68 [Last accessed 26 June 2018].
NHS England. (2017) A-EQUIP: We welcome the new model of midwifery supervision. Available from: https://www.england.nhs.uk/blog/a-equip-we-welcome-the-new-model-of-midwifery-supervision/ [Last accessed 26 June 2018].
NICE. (2012) Caesarean section: clinical guideline [CG132]. Available from: https://www.nice.org.uk/guidance/cg132/chapter/1-Guidance [Last accessed 26 June 2018].
NICE. (2013) Caesarean section: quality standard [QS32]. Available from: https://www.nice.org.uk/guidance/qs32/chapter/quality-statement-1-vaginal-birth-after-a-caesarean-section. [Last accessed 8 June 2018].
NMPA (2018). National Maternity and Perinatal Audit: clinical report 2017. RCOG London. Available at: https://maternityaudit.org.uk/downloads/NMPA%20Clinical%20Report%202018… [Accessed 21st August 2019]
RCOG. (2015) Birth after previous caesarean birth. Royal College of Obstetricians and Gynaecologists, Green-top guideline, 45. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_45.pdf [Last accessed 8 June 2018]
RCOG. (2015b) Obtaining valid consent - Clinical Governance Advice No. 6. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/clinical-governance-advice/cga6.pdf. [Last accessed 26 June 2018].
RCOG. (2016) Birth options after previous caesarean section. Available from: https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-birth-options-after-previous-caesarean-section.pdf. [Last accessed 8 June 2018].
Royal College of Midwives. (2015) VBAC is clinically safe, says RCOG. Available from: https://www.rcm.org.uk/news-views-and-analysis/news/vbac-is-clinically-safe-says-rcog. [Last accessed 26 June 2018].
St Georges University Hospitals NHS Trust. (2017) Professional Midwifery Advocates. Available from: https://www.stgeorges.nhs.uk/service/maternity-services/5-professional-midwifery-advocates-pma/. [Last accessed 26 June 2018