“When Belle was born I went through such a mixture of emotions,” says Angela. “On the one hand I had this beautiful baby, and should have been so grateful, but on the other hand I had all this grief about what I had missed out on and what could have been. When people asked me about the birth I would say ‘I had to have a caesarean’ and they would often say ‘what a shame’. You know all I heard when they said that was ‘shame on you.’ It was silly, I know, but I yearned for a normal birth. It actually obsessed me.”

Looking back Angela sees things more in perspective now but she believes it took the normal vaginal birth of her son Sam two years later to make her let go of the pain surrounding that first birth. “Birthing Sam was such a pinnacle in my life,” she says. “I felt so powerful after that, I felt I could have literally done anything. I mean vaginal birth isn’t the only way to have a baby, I know that, but it is important to many women and that needs to be acknowledged.”

There are many reasons why a woman may want to have a vaginal birth after a caesarean. Some of these reasons are to avoid the physical impact of caesarean section and others are the emotional desire to give birth vaginally to a baby.

Becoming pregnant after a previous caesarean section can be a time of worry for women.

They may not know where to turn for balanced information or support. Every woman wants to do the best thing for herself and her baby when it comes to the birth.

More than 1 in 4 women giving birth have a caesarean in Australia. This varies depending on where a woman gives birth and whether or not she has private health insurance. For women who give birth in public hospitals the caesarean section rate is around 23 percent compared to nearly 34 percent for women who give birth in private hospitals. Many women who have a caesarean will go on to have another baby.

For them the choice of having a vaginal birth after a caesarean (VBAC) or having a repeat caesarean may be difficult. While we know the likelihood of a woman having a VBAC is between 60 and 80 percent, in Australia around 25 percent of women have a VBAC. This varies between hospitals and even states and appears to be more to do with the attitude of doctors and institutions to VBAC than the abilities or desires of women to have a vaginal birth.
Why are some doctors reluctant for women to have VBACs?

Since the early 1980’s the rate of VBAC has risen steadily as research showed its safety and women voted with their feet. In the mid 1990’s there was an increase again in the promotion of elective repeat caesarean by doctors as a safer option. The increased safety of caesarean section over the years has certainly made this a more reasonable option for women. The main reason behind the decline in VBAC, however, is the risk of litigation. A couple of successful malpractice suites involving VBACs made obstetricians nervous and the fact they rarely get sued for doing a caesarean makes VBAC a safer option for them.  If safety guidelines are followed the reality is VBAC is as safe as planned caesarean for the baby, safer for the mother, and much safer for any future pregnancies.

Who is a candidate for VBAC?

If you have had a low transverse incision on both your abdomen and uterus then you are a good candidate for a VBAC. Caesarean incisions are divided into two main types: classical (up the middle of your abdomen) and lower segment (along your bikini line). Lower segment caesarean sections are the most common incisions used. Having your baby with its head pointing downwards and wanting a VBAC are also important prerequisites. Women who really want a VBAC are more likely to be successful. Women who have had two previous low-transverse caesarean sections can consider a VBAC. The risk of uterine rupture increases with the number of previous caesareans. Women who have had a vaginal birth at least once before or after their previous caesarean are the most successful candidates for VBAC.

If you have had a low transverse incision on both your abdomen and uterus then you are a good candidate for a VBAC. Caesarean incisions are divided into two main types: classical (up the middle of your abdomen) and lower segment (along your bikini line). Lower segment caesarean sections are the most common incisions used. Having your baby with its head pointing downwards and wanting a VBAC are also important prerequisites. Women who really want a VBAC are more likely to be successful. Women who have had two previous low-transverse caesarean sections can consider a VBAC. The risk of uterine rupture increases with the number of previous caesareans. Women who have had a vaginal birth at least once before or after their previous caesarean are the most successful candidates for VBAC.

Page revised on 17th December 2021