If you have given birth by Caesarean Section (CS) in the past you might wish to try for vaginal birth in the next pregnancy, instead having a planned CS.

VBAC stands for Vaginal Birth After Caesarean section.

The method of delivery is based on your unique medical and obstetric history and on the specific characteristics of your pregnancy. In order to decide if VBAC is the right choice for you it is crucial to know:

  • The reason why you gave birth by CS in the past and whether this was a planned or an emergency CS
  • The type of the uterine incision
  • If there are contraindications against vaginal birth

Advantages of vaginal birth after CS

  • Increases the chances of vaginal birth in future pregnancies
  • Shorter convalescence
  • Less pain compared to CS

Prerequisites for successful VBAC

Around 3 in 4 women (75%) with uncomplicated pregnancy and spontaneous onset of labour could eventually deliver vaginally after CS. If they have given birth vaginally in the past, then 9 out of 10 women (90%) could deliver vaginally.

Factors that reduce the chances of a successful VBAC

  • Possibility of emergency CS
    Every woman in labour has a 20% chance of delivering by CS. The risk for women who had a previous CS is slightly increased (25%).
  • Blood transfusion and infection
    The risk of blood transfusion and infection is 1% increased in VBAC compared to a planned CS.
  • Caesarean Scar incision rupture
    The risk of CS incision rupture is 0.5% (2-8 in 1000 women). If there is suspicion of CS incision rupture an emergency CS needs to be performed.

Contraindications for vaginal birth after CS

  • History of 2 or more Caesarean Sections
  • History of uterine rupture
  • Classical CS
  • Contraindications from the current pregnancy i.e. placenta praevia

Advantages of a planned CS

  • There is almost no risk for uterine rupture
  • No risk to the fetus
  • Delivery is planned

Disadvantages of a planned CS

  • Technically more difficult operation compared with the first CS, mainly due to the presence of adhesions and possible complications associated with the placenta (i.e. placenta accreta)
  • Increased risk of deep venous thrombosis (1 in 1000 women)
  • 3-4% of fetuses born by elective CS might need respiratory support