Vaginal birth after caesarean (VBAC)

If you've had a caesarean birth, there are several birth options to consider when you have another baby. A vaginal birth after caesarean (VBAC) is having a vaginal birth after having a previous caesarean (C-section).

Many women plan a VBAC, while others plan another caesarean.

If you've had a caesarean birth, talk to your doctor, midwife or obstetrician about future births. It's important to discuss:

• the benefits and risks of a planned VBAC compared with a planned caesarean
• your medical situation
• your birthing preferences

The choice to have a planned VBAC is personal. The choice should be made with your partner and healthcare team.

Some benefits of vaginal births (including VBACs) compared with caesareans include:

• a lower risk of some complications, such as infection or blood clots
• a shorter recovery time and hospital stay
• a lower risk of complications during future pregnancies
• less pain after birth
• being more physically able to care for your baby soon after delivery

Babies born vaginally have a lower risk of breathing problems. Delivering vaginally may also help you with starting and continuing to breastfeed your baby.

There are some risks with a planned VBAC.

Emergency caesarean

There is a risk you will need an emergency caesarean. About 1 in 4 women who plan a VBAC may need an emergency caesarean.

Emergency caesareans have a higher risk of complications compared with a planned caesarean.

Scar rupture

There is a small risk of the caesarean scar in your uterus tearing during labour. The medical term for this is 'uterine rupture'. The risk is very low — about 5 to 7 in every 1,000 VBACs.

A uterine rupture can cause serious problems for you and your baby. In very rare situations, you may need a hysterectomy (removal of your uterus).

Other risks

If you have a vaginal birth, there is a risk of having trauma to your perineum and pelvic floor.

The success rate for planned VBAC varies greatly. For some women, there is a chance that you will need an emergency caesarean.

Your chances of having a successful planned VBAC are higher if:

• you've had a previous vaginal birth, especially if you've had a successful VBAC
• you go into labour naturally, without being induced
• you have a low-risk pregnancy
• the reason for your previous caesarean was related to your baby's position at the time of birth (for example, a breech position)
• your weight is within a normal range

There are sometimes when a VBAC may not be recommended. These can include when you have:

• had a previous complicated caesarean
• had 3 or more previous caesareans
• had a previous rupture of your uterus
• placenta praevia (a low-lying placenta)
• a transverse position late in pregnancy (your baby is lying across your uterus, rather than head down)

The type of caesarean you had previously, including the technique used, also needs to be considered.

Your healthcare team may advise extra caution if you:

• had a caesarean less than 18 months ago
• have had 2 previous caesareans
• are pregnant with more than one baby
• are delivering a large baby

All labours and births are unique and a planned VBAC is no different.

Let your healthcare team know your wishes for your labour and birth beforehand. This helps them to provide safe and respectful care.

Due to the risk of uterine rupture, doctors and midwives usually recommend you have a planned VBAC in hospital. This is so that you and your baby can be monitored closely during labour. This helps your healthcare team to detect any problems early.

In terms of pain management during labour, the usual options are available to you, including:

• an epidural
• other medicines
• non-medical options

If complications do happen during labour and birth, your healthcare team will inform you and recommend next steps. Keep in mind about 1 in every 4 women who plan a VBAC may need to have a caesarean. While you may not be able to predict this ahead of time, understanding this can help you to better make decisions during your labour and birth.

Your location and access to medical care

Some remote and regional hospitals may not offer care for women wanting a planned VBAC. This is because they may not be equipped to handle unplanned (emergency) caesareans or other complications. If you are in this situation and would like to have a planned VBAC you can:

• talk with your healthcare provider
• ask to go to another hospital that can safely support and accommodate your choice

A planned VBAC or a repeat caesarean are both safe ways to give birth for most women. But each person's preferences differ.

Being well informed and understanding your own circumstances may help with your decision making.

Things that are important to understand and discuss with your healthcare team are:

• when and why you had your previous caesarean
• whether there were complications in your last birth or pregnancy
• the type of cut (incision) that was made in your uterus
• whether you have any complications in your current pregnancy
• how you feel about your last birth
• how many children you hope to have

Questions you may want to ask your doctor or midwife

• What are my options for labour and birth?
• Where can I have a planned VBAC?
• What is the likelihood that I will have a successful VBAC?
• What are the risks to me and my baby if I choose a planned VBAC or a caesarean birth, and how likely are these risks?
• What are the benefits to me and my baby if I choose to have a planned VBAC or a caesarean birth?

Ask your doctor or midwife for advice about VBAC.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists has information on vaginal birth after caesarean section.

Queensland Health also has an information sheet on VBAC.