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Birth after C-section

Understanding your options for this baby

If you’ve had a caesarean delivery before, there are two ways your next baby can be born:

  • A vaginal birth after caesarean (VBAC) — labouring and giving birth vaginally
  • An elective (planned) repeat caesarean — a planned operation, usually arranged in advance

Both are reasonable choices for most women. The right one depends on your medical history, your preferences and the way this pregnancy is going. This page explains both, so you can have an informed conversation with your obstetrician.

What is VBAC?

Vaginal Birth After Caesarean (VBAC) is the term used when a woman gives birth vaginally, having had a caesarean delivery in the past.

For most women who choose to try for a VBAC, the chance of a successful vaginal birth is about 70–75%. Many factors influence your individual chances, including whether you’ve had a previous vaginal birth (which increases success significantly), the reason for your previous caesarean, and how your current pregnancy is progressing.

What is an Elective Repeat Caesarean?

An elective caesarean is a planned caesarean. The date is usually planned in advance at your antenatal appointments, and the operation is carried out at around 39 weeks — waiting until 7 days before your due date significantly reduces the chance of your baby having breathing problems after birth.

Most women with two previous caesarean deliveries will have their next baby by caesarean. However, if you go into labour spontaneously, your chance of a successful vaginal birth is slightly less than for women with one previous caesarean — between 70% and 75%.

What are my chances of a successful VBAC?

A number of factors make a successful vaginal birth less likely:

  • You have never had a vaginal birth
  • You need to be induced
  • You did not make progress in your previous labour and needed a caesarean (usually because of the position of the baby)
  • You are overweight — a BMI over 30 at booking

Conversely, your chances of a successful VBAC are higher if:

  • You’ve had a previous vaginal birth, especially a successful VBAC
  • You go into labour spontaneously, without needing to be induced
  • The reason for your previous caesarean was related to the position of your baby at the time (for example, breech) — i.e. a “non-recurring” reason
  • You’re at a healthy weight

Your obstetrician will look at your individual history and help you weigh up your chances.

Disadvantages of VBAC

It’s important to understand the small but real risks of VBAC — particularly the rare possibility of scar rupture.

  • Emergency Caesarean delivery There is a chance you will need an emergency caesarean during labour. This happens in 25 out of 100 women (25%) attempting a VBAC. This is only slightly higher than for women labouring for the first time (20%). The usual reasons are labour slowing or concern for the wellbeing of the baby.
  • Blood transfusion and infection in the uterus Women choosing VBAC have a 1 in 100 higher chance of needing a blood transfusion or having a uterine infection, compared with women who choose a planned caesarean.
  • Scar weakening or scar rupture There is a chance the scar on your uterus will weaken and open. If the scar opens completely (scar rupture), this can have serious consequences for you and your baby. It occurs in only 2 to 8 in 1,000 women (about 0.5%) attempting a VBAC. Being induced increases the chance. If there are signs of these complications, your baby will be delivered by emergency caesarean.
  • Risks to your baby The risk to your baby is no higher than if you were labouring for the first time. The disadvantages listed above are more likely in women who attempt VBAC and are unsuccessful.

When is VBAC not advisable?

There are very few occasions when VBAC is not advisable. These are when:

  • You have had three or more previous caesarean deliveries
  • The uterus has ruptured during a previous labour
  • You have a high uterine incision (a classical caesarean — usually done for very preterm caesareans)
  • You have other pregnancy complications that require a caesarean delivery

In these situations, your obstetrician will recommend an elective caesarean and discuss the reasons with you.

Elective repeat caesarean, pros and cons

Pros

  • Virtually no risk of uterine scar rupture The principal benefit, particularly if scar rupture would be especially serious in your case.
  • You know the date Useful for arranging childcare for older children, your partner’s work, and your own preparation.

Cons

  • A longer and possibly more difficult operation A repeat caesarean usually takes longer than the first, because of scar tissue. Scar tissue may also make the operation more difficult and can occasionally result in damage to the bowel or bladder. There are rare reports of accidental cutting of the baby at caesarean delivery.
  • Breathing problems for your baby Breathing problems are quite common after caesarean delivery and usually do not last long. Occasionally, the baby will need to go to the Special Care Baby Unit. Between 3–4 in 100 babies (3–4%) born by planned caesarean have breathing problems, compared with 2–3 in 100 (2–3%) following VBAC. Waiting until 7 days before the due date minimises this problem.
  • A need for elective caesarean in future pregnancies More scar tissue occurs with each caesarean delivery. This increases the possibility of the placenta growing into the scar, making it difficult to remove (placenta accreta or percreta). This can cause bleeding and may require a hysterectomy. All serious risks increase with every caesarean delivery you have.
  • Increased risk of peripartum hysterectomy The rate of hysterectomy at the time of a first vaginal delivery is 1 in 30,000. Following a first caesarean section, the rate of risk increases to 1 in 7,000, and continues to rise with each subsequent caesarean.

Frequently asked questions

What happens if I have an elective caesarean planned and I go into labour?

Telephone the hospital to let them know what is happening. It is likely that an emergency caesarean will be performed once labour is confirmed. If labour is very advanced, or if labour is early (before 37 weeks), then VBAC may be more suitable. Your obstetrician will discuss this with you.

Yes. An epidural is compatible with VBAC and is widely used. Your team will discuss it with you.

Yes — your baby’s heart rate will be monitored continuously, usually using a sensor on the abdomen. This allows your team to spot any early signs of trouble with the scar.

Yes. The decision can be revisited at any point during pregnancy, and even early in labour. If you’ve planned a caesarean and go into labour spontaneously and very quickly, VBAC may be a good option on the day. Conversely, if you’ve planned a VBAC and circumstances change, a caesarean can be performed.

After a previous caesarean, we recommend a hospital birth on the consultant-led labour ward, where emergency facilities are immediately available if needed.