What is a VBAC?

A vaginal birth after caesarean (VBAC) refers to attempting a vaginal birth after having a previous caesarean. This can be a safe and positive way to have a baby for those who wish to avoid another caesarean birth.

What are my chances of having a successful VBAC?

The choice to have a VBAC is personal and should be made with your healthcare team.

The chances of a successful VBAC vary greatly, depending on your own case. Research on this topic shows success rates of between 30% and 80%. For this reason, it’s important to discuss the risks, benefits and your birthing preferences with your doctor and midwife.

How do I plan for a VBAC?

If you’d like to have a VBAC, it’s a good idea to discuss this with your healthcare team early in your pregnancy. This way, you will have enough time to understand your options and make a decision that is right for you.

Your chances of having a successful VBAC are generally considered to be higher if:

• you have had a previous vaginal birth or a previous successful VBAC
• you had a low transverse incision on the uterus during the previous caesarean
• you go into labour naturally, without being induced
• you have an uncomplicated low-risk pregnancy
• the reason for your previous caesarean was related to your baby’s position at the time of birth (for example, a breech position)
• your weight is within a normal range

There are certain circumstances when a VBAC may not be recommended. These include:

• previous complicated caesarean or classical incision on the uterus
• placenta praevia
• previous uterine rupture
• more than 3 previous caesareans
• your baby’s position is transverse (lying across your uterus, rather than head down)

If you have had a caesarean less than 18 months ago or had 2 previous caesareans, or if you are pregnant with more than 1 baby or your baby is suspected to be large, your healthcare team may also advise extra caution.

Your location and access to medical care

Doctors usually recommend that women choosing a VBAC have their baby in a hospital instead of at a birthing centre or as a home birth. This is so you can be monitored and quickly get medical support if complications happen. Although, where you choose to birth is your decision.

Some remote and regional hospitals may not offer VBAC. This is because they may not be properly equipped to handle unplanned (emergency) caesareans. If you are in this situation and would like to have a VBAC you can:

• talk with your healthcare provider
• ask to go to another hospital that can safely support and accommodate your choice

How do I decide if a VBAC is right for me?

A VBAC or a repeat caesarean are both safe ways to give birth for most women. But each person’s preferences differ. Being well informed and understanding your own circumstance may help inform your decision making.

Things that are important to understand and discuss with your healthcare team may include:

• the reason you had your caesarean(s)
• when you had your last caesarean
• whether or not you have had a vaginal birth before
• whether there were complications in your last birth or pregnancy, and if they still exist
• the type of cut (incision) that was made in your uterus
• whether you have complications in your current pregnancy
• how you feel about your last birth
• how many children you hope to have

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 may also 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 uterus tearing during labour, the medical term for this is uterine rupture. The risk is very low — about 5 to 7 in every 1,000 VBACs. However, this is the main reason doctors and midwives recommend that you give birth in hospital and they monitor you and your baby closely during labour.

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

There is also the chance that you will need an emergency caesarean during labour. Typically, about 1 in 4 women who plan a VBAC may need an emergency caesarean. This can increase the risk of bleeding and infection compared with a planned caesarean.

How will I be cared for if I choose a VBAC?

All labours and births are unique and attempting a VBAC is no different. It’s important to tell your healthcare team your wishes for your labour and birth before labour begins. This helps them to provide safe and respectful care. However, keep in mind that sometimes things can change during labour and birth.

If you choose to have a VBAC, it is usually recommended that you birth in a hospital, rather than at home or in a birthing centre. This is because if a uterine rupture happens, a hospital can better manage any complications if they arise. Some hospitals may offer midwife-led care for women having a VBAC, but you will need to discuss this with them early on in your pregnancy to confirm the available models of care.

Your healthcare team will usually recommend that you contact them once you think you are in labour or if your waters break.

Once you are in labour, they may recommend that your contractions and baby’s heart rate are monitored continuously with a cardiotocography (CTG). This helps your healthcare team to detect problems early, should they arise. Your healthcare team will also monitor your blood pressure, heart rate and vaginal loss (any fluids that come out of the vagina).

In terms of pain management, all of the usual options, including epidural, are available to you, including other medical and non-medical options.

If complications arise during labour and birth, your healthcare team will inform you and recommend next steps. Keep in mind about 1 in every 4 women who attempt a VBAC may need to have a caesarean. While you may not be able to predict this ahead of time, understanding this can help you to better make decisions during your labour and birth.

Resources and support

As well as asking your doctor or midwife for advice, you can get support and information from:

• The Australian Birth Trauma Association offers advice, resources and a peer-to-peer support service.
• The Centre of Perinatal Excellence (COPE) provides information and a list of support services.
• Perinatal Anxiety and Depression Australia (PANDA) — call 1300 726 306 to speak with a counsellor (Mon to Fri, 9am to 7.30pm AEST).