Vaginal Birth After Caesarean (VBAC)

The incidence of caesarean births is on the rise. In the past caesareans were not common, but now in Australia almost 1:3 women will give birth by caesarean. Australia greatly exceeds the World Health Organisations recommendation that the caesarean birth rate should not be greater than 10-15%. If a woman gave birth by caesarean, it used to be thought that she could only give birth by caesarean in the future – hence the saying ‘Once a caesarean always a caesarean’. This viewpoint however is not based on research. Given the right support, women who give birth by caesarean have around 70 to 80% chance of giving birth vaginally the next time.

A trial of labour after a previous caesarean has been proven to be the safest choice for mother and baby. A woman who has a repeat caesarean without labour has an increased risk of developing an infection or bleeding compared to a woman who attempts a vaginal birth. The risks to the baby of an elective caesarean include an increased chance of respiratory distress syndrome. The reason for the previous caesarean has to be taken into account, but overall attempting a vaginal birth after a caesarean is usually preferable for health reasons.

The best way to avoid another caesarean birth is by choosing the healthcare practitioner carefully.

Some healthcare practitioners automatically offer another caesarean, while others will actively assist women to achieve a normal birth. Detailed information on vaginal birth after caesarean, including supportive healthcare practitioners, is available on Birthrites Facebook page.

Some women choose to be well prepared for a vaginal birth after caesarean. Probably the most common preparation women undertake is reading. Reading anything they can lay their hands on including VBAC articles in journals and magazines, books and websites. Other strategies women have used with success include enlisting the help of supportive friends and choosing the birth team carefully. Communication is important with those involved with pregnancy and birth. Women can use a birth plan as a communication tool or may even hold a meeting with their birth team prior to the due date. Physical fitness can potentially improve chances of a successful outcome (though it cannot guarantee it). Exploring fears prior to birth with a friend or health professional can be helpful. Importantly, a woman aiming for a VBAC should have balance in her life and avoid focusing solely on birth.

I had a caesarean section for the birth of my first baby because my baby became distressed. I would like to try for a normal birth next time. What is the risk of the scar on my uterus rupturing if I go into labour naturally?

The risk of your uterus rupturing during labour when you have had a previous caesarean depends on the type of incision on your uterus. The most common incision is known as a low transverse incision. This type of incision is the safest and research indicates that the risk of rupture is less than 0.5%. Occasionally another incision known as a classical incision is used. Typically this type of incision is only used for specific medical indications. A classical incision is more likely to rupture than a low transverse incision.

Labour induced by drugs, such as Syntocinon or Prostaglandins, increases the chance of scar rupture. A recent finding by research indicates that if a woman goes into labour within 18 months of having a caesarean that the risk of the scar rupturing also increases. The term rupture is a little misleading, however. Most times when the scar ruptures (or comes apart) – it does so only to a minor degree and causes no obvious problems for mother or baby. It’s important to know that a serious rupture of the uterus is a rare complication.

Does two caesareans always mean a third? My last two babies were breech, if my third baby is the right way around can I give birth naturally?

No, two caesareans does not necessarily mean a third. Research has found that women attempting vaginal birth after two caesareans should be treated no differently than a woman who has had one previous caesarean. The key here will be finding a midwife or doctor who will support you in giving birth naturally. Some healthcare practitioners will be supportive while others will not.

Please help, my last baby was born by caesarean. I would like a normal birth this time but the hospital and obstetrician all say that a repeat caesarean is my only option.

Vaginal birth after caesarean has been found by research to be the preferred option in most cases. The reason for your caesarean, of course, plays a role in the decision on whether or not to try for a vaginal birth. Research your options and become informed. Contact your local VBAC group. You can present your preferences to the obstetrician and the hospital – and see what their response is. They may continue with their current opinion or support your choices. You may choose to seek a second opinion. You may even need to look for a different caregiver or birthplace – if you do not receive the desired support you are after.

I would like to try for a normal birth with my next baby (I had a caesarean last time). Can you let me know any good books on the subject?

There are a number of books that you may be able to get hold off. Here a list of a few books that you may find helpful:

Nancy Wainer Cohen & Lois J Estner, 1983 (USA). Silent Knife. If you can get hold of a copy – this is a great book.
K. Crawford & J. Walters, 1996 (USA). Natural childbirth after caesarean – A practical guide.
Nancy Wainer Cohen, 1991 (USA). Open season. This book is a follow on from Silent Knife.
Andrea Frank Henkart, 1995 (USA). Trust your body! Trust your baby – caesarean wisdom and caesarean prevention

You could try to obtain the above books from your local library, Childbirth Education Association, Baby Health Clinic, and Nursing Mother’s Association Australia or you may be able to purchase these and other books from:

Birth International
Phone 02 9519 5377
Fax: 02 9519 5122
PO Box 366 Camperdown NSW 1450
Email: sales@birthinternational.com
Website: www.birthinternational.com

Capers
47 Arthur Terrace, Red Hill QLD 4059
Phone: 07 3369 9200
Fax: 07 3369 9299
Website: www.capersbookstore.com.au

Both organisations will post a free catalogue.

The following are some pamphlets (available from the above organisations) that you may find helpful:

VBAC Checklist – Ideas to help you prepare for a VBAC.
Yes, I’m having a VBAC.
So You’re Thinking About VBAC…
Caesarean Fact Sheet – 1991.

I have also included a few websites here that you may find useful:

Originally published in 2000

Page revised 9th December 2021

About the Author

Jane Palmer works as a private midwife located in Sydney, Australia. With additional qualifications as a childbirth educator and lactation consultant, Jane supports families throughout the greater metropolitan area of Sydney.