Vaginal Birth After Caesarean

Caesarean section is a common surgical procedure. Up to one woman in four in Australia and New Zealand has a baby delivered by caesarean section. For decades it had been generally assumed that once a woman had a caesarean section, all her future babies would have to be delivered by caesarean section. However, this concept has changed due to improvements in obstetric care and surgical techniques. Many women who have had a caesarean section can safely give birth through the vagina during a subsequent labour. This is known as vaginal birth after caesarean section (VBAC). With careful selection of patients and good obstetric care, about five to eight women out of 10 who attempt VBAC are successful.

The decision to attempt VBAC

To decide, your doctor will consider factors such as:

  • the location of the uterine scar from the caesarean incision
  • the reason for the previous caesarean section
  • how you want to deliver this baby
  • your access to a hospital that is well equipped for an emergency caesarean section
  • how many more babies you hope to have
  • the time since your previous caesarean section (uterine scars less than two years old may have a greater risk of rupture).

Risks of VBAC

VBAC is associated with a small risk of rupture of the uterine scar. This rupture can be caused by the uterus's forceful contractions during labour and pressure against the scar. Rupture of a uterine scar is an uncommon but serious complication.
The signs of uterine rupture can be difficult to detect. A woman may have some bleeding or pain between contractions, but changes in the baby's heart may be the first sign of uterine rupture.
Rupture of the uterine scar can be life-threatening for the mother and baby, and an emergency caesarean section will be necessary.

Rupture of the uterine scar occurs about one in every 200 VBAC attempts. Of those women who do have a uterine rupture during VBAC:

  • about one in 10 of these women will need a hysterectomy (uncommonly, a woman may need a hysterectomy following uncontrollable bleeding during an elective caesarean section)
  • about one birth in 20 uterine ruptures can result in stillbirth.