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Alternative Names 
vaginal birth after caesarean section, vaginal birth after caesarean delivery

VBAC is delivering a child vaginally after a previous delivery by caesarean section .

What is the information for this topic? 
Many women choose to attempt a vaginal delivery even if they have had a previous caesarean section. The doctor and the woman should discuss the risks and benefits together. If a woman does not want to try a vaginal delivery, it is her choice.

There are several reasons to consider a vaginal birth after a previous caesarean section.
  • There is less risk with a vaginal delivery, since a caesarean section is major surgery. All surgeries carry a risk from anaesthesia, infection, and bleeding. In addition, the recovery time with a vaginal delivery is shorter. Healing from an abdominal incision can take weeks.
  • The woman should also consider her involvement in the birth. General anaesthesia is occasionally necessary for a caesarean section. The mother may not be able to take part in the birth of her child. A vaginal birth can be a rich personal experience.
  • Some women fear the pain involved in labour during a vaginal delivery. There are many ways to ease the pain.
There are some risks with vaginal delivery after a caesarean section. There is up to a 1% risk of a tear in the uterine wall. This leads to a risk of foetal death and foetal brain damage. This risk is low with the most common type of uterine incision. This is the low transverse incision made across the lower, thinner part of the uterus. It heals with a stronger scar. It is less likely to cause problems in vaginal delivery.

A classical incision is an up-and-down incision into the upper uterus. There is a 10% risk of uterine tearing with this incision. It is important to discuss this with a doctor. Delivery records may need to be reviewed. After having a classical incision, most women are advised not to attempt a vaginal delivery.

There are other risk factors with vaginal delivery that may make a caesarean section preferable.
  • A small pelvis and a large baby could cause problems.
  • Twins or triplets may be in unusual positions in the uterus.
  • The baby may have a breech presentation. This is when the baby's buttocks or feet are close to the cervix and present first.
  • The mother may have health problems, such as diabetes, preeclampsia, high blood pressure, or severe heart disease.
VBAC success can vary. It can be harder with women older than 35 years. If the baby is over 4000 grams, or roughly 9 pounds, success is less common. If the woman has never had a vaginal delivery, VBAC is harder. However, even in these cases, up to 60% of women can have a vaginal delivery.

Success rates, risks, and benefits must be discussed. A discussion of the risks and benefits of another caesarean section is also important. The birth must be monitored in a hospital in case there are problems. Intravenous hydration, blood transfusions, foetal monitoring, and an operating room must be ready. Foetal monitoring is especially important. The mother's contraction pattern may warn of foetal distress or a tear in the uterus.

The decision to try VBAC should be made after counselling about the risks and benefits. Only after discussion can the best decision be made. There is often a reasonable chance of a successful vaginal delivery of a healthy infant.

Author: Eva Martin, MD
Reviewer: eknowhow Medical Review Panel
Editor: Dr John Hearne
Last Updated: 19/12/2004
Potential conflict of interest information for reviewers available on request

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