What is a VBAC?

The old saying ‘once a caesarean, always a caesarean’ no longer holds true. A vaginal birth after caesarean (VBAC), can be a safe and positive way to have a baby.

Women who’ve given birth by caesarean section (C-section) usually have the option to deliver their next baby vaginally. But if your doctor thinks there are health concerns or risks with a VBAC, they may recommend an elective caesarean.

What are my chances of having a VBAC?

The choice to have a VBAC is a personal one. But it should be based on medical advice. It’s important to discuss the risks and complications with your doctor and midwife. That way you can make an informed choice.

Whether a VBAC is suitable for you will depend on your health and your baby’s health. Your location and access to medical care is also important.

Your health and your baby’s health

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

Your doctor may recommend a planned C-section birth if:

• you have previously had a complicated C-section
• 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
• you have a multiple pregnancy (for example, twins, triplets or more)
• it is less than 18 months since your previous pregnancy
• you have a pregnancy complication that prevents you having a vaginal birth. (For example, high blood pressure, your baby is in the breech position or there is concern about the size or health of your baby.)

A repeat elective (planned) caesarean may be more complicated than your previous C-section because of the scar tissue. There are risks when having major surgery such as infections and blood clots.

Your location and access to medical care

Doctors usually recommend that women choosing a VBAC deliver their baby in a hospital instead of a birthing centre or home birth. This is so you can be closely monitored and get the best medical support if any complications develop.

Some remote and regional hospitals do not offer VBAC, as they are not properly equipped to handle unplanned (emergency) C-sections.

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.

What are the benefits of having a VBAC?

Some benefits of vaginal births (including VBACs) include the following:

• A lower risk of some complications such as infections or blood clots.
• A shorter recovery time and hospital stay.
• A lower risk of complications during future pregnancies.
• Less abdominal pain after birth.
• Being more physically able to care for your baby (and any other children you may have) soon after delivery.
• Babies born vaginally have a lower risk of breathing problems.

Delivering vaginally can improve the chance of starting and continuing to breastfeed your baby.

What are the risks of having a VBAC?

There is a small risk of the scar in your womb (uterus) and abdomen tearing during labour. The risk is very low – about 5 to 7 in every 1000 VBACs. But this is the main reason doctors and midwives closely monitor the labour during a VBAC.

A rupture of the scar can result in serious problems for you and your baby. In very rare situations where there is severe bleeding, a hysterectomy (removal of the uterus) may be required.

There is a chance you will need an emergency C-section during labour. This has increased risks of bleeding and infection compared with a planned caesarean.

How do I plan for a VBAC?

If you’d like to have a VBAC, discuss your birth options early in your pregnancy, either with your doctor or midwife. 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 (inducing labour with medicines can make the contractions very strong, putting extra strain on your scar)
• you are not overweight or obese

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

• 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

Many women find a VBAC a healing experience, particularly if a previous birth has been traumatic.

Your doctors and midwives will closely monitor you and your baby during your labour and they will advise you if complications arise.