The old adage ‘once a caesarean, always a caesarean’ no longer holds true for many women.

Women who’ve given birth by caesarean section usually have the option to deliver their next baby vaginally. However, if your doctor believes that there are medical concerns or risks with a VBAC, they are likely to recommend an elective caesarean.

Your chances of having a VBAC

Although the decision to have a VBAC is a personal one, it should be based on careful and thorough medical advice. Whether or not a VBAC is suitable for you will depend on 2 main things — you and your baby’s health, and your location.

Your health

The chances of having a successful VBAC are higher if you and your baby are in good health and your pregnancy is progressing normally.

In contrast, your doctor may recommend a planned caesarean if:

• you have previously had a complicated caesarean section, such as a caesarean section through the upper part of the uterus (called a classical caesarean)
• you have a pregnancy complication that prevents you having a vaginal birth, regardless of your history (for example, high blood pressure, your baby is in the breech position or there is concern about the size or health of your baby)
• the reason you had your previous caesarean still exists
• you’ve had 3 or more caesareans
• your uterus has ruptured previously
• you have had previous surgery to your uterus, such as removal of fibroids (though VBAC may still be possible — discuss with your doctor)
• you have previously had a hysterotomy (an incision through the muscle of the uterus)
• you have a multiple pregnancy (for example, twins, triplets or more)
• it is less than 18 months since your previous pregnancy

A planned caesarean may be a longer and more complicated operation than your previous caesarean because of the scar tissue. There are also risks of having major surgery such as infections and blood clots. If you have another caesarean, all future births are likely to also be by caesarean.

Your location

Doctors usually recommend that women choosing a VBAC deliver their baby in a hospital instead of using a birthing centre or having a home birth. This is because close monitoring is needed so that any complications can be addressed quickly. For this reason, some remote and regional hospitals do not offer VBAC, as they are not properly equipped to handle unplanned (emergency) caesareans.

If you wish to have a VBAC, it’s best to select a hospital or midwife-led care provider in your area that offers VBAC.

Benefits of VBAC

Some benefits of vaginal births — including VBACs — are:

• a lower risk of some complications such as infections or blood clots
• a shorter recovery time and hospital stay
• a higher likelihood that you can feed and cuddle your baby straight after birth
• a lower risk of complications during future pregnancies
• less abdominal pain after birth
• you are more physically able to care for your baby (and any other children you may have) soon after delivery, allowing for quicker bonding
• babies born vaginally have a lower risk of respiratory problems

Risks of VBAC

The risk of the scar in your womb (uterus) and abdomen tearing during labour is very low — about 5 to 7 in every 1000 VBACs — but this is the main reason doctors and midwives closely monitor VBACs in a properly equipped hospital. A rupture of the scar can result in serious problems for the baby (death or brain injury) and for you (serious bleeding). For most women, any tear can be repaired, but in very rare situations where there is severe bleeding, a hysterectomy (removal of the uterus) may be required.

Women opting for a VBAC also have a higher likelihood of delivering via an emergency caesarean, which increases the risk of uterine infection and bleeding compared with an elective caesarean.

Plan ahead

If you’d like to have a VBAC, discuss your birth options early in your pregnancy, either with an obstetrician or your hospital’s obstetric unit. Get a second opinion if you don’t feel comfortable or need someone more supportive.

A VBAC is more likely to be successful if you have previously given birth vaginally, this pregnancy is straightforward, you go into labour spontaneously, you are not overweight or obese, and the previous caesarean was done because of a breech presentation, placenta praevia or fetal distress.

If you decide to go ahead with a VBAC, you can do things to boost your chances of having a successful and positive experience, such as:

• learn about VBAC — read about it and take a VBAC childbirth class with your partner or another loved one
• choose a well-equipped hospital that offers VBAC
• eat healthily and keep active during your pregnancy
• allow your labour to start naturally, if possible — inducing labour with medicines can make the contractions very strong, putting extra strain on your scar
• be prepared for a caesarean — even though you have your heart set on a VBAC, you may need to have a caesarean if complications arise. The aim is to have a healthy mother and baby, regardless of how you get there