At Obstetric Care, we believe that informed decision-making is central to achieving the best possible birth experience. Whether you are considering a VBAC or planning a repeat caesarean section, our role is to provide personalised advice, careful monitoring, and evidence-based guidance so that you can make the choice that feels right for you and your baby.
What is a VBAC?
A Vaginal Birth After Caesarean (VBAC) refers to giving birth vaginally after having had one or more previous caesarean deliveries. If labour progresses successfully and the baby is born vaginally, it is considered a successful VBAC.
In the UK, national guidance supports offering most women with a single previous lower segment caesarean section the opportunity to consider a VBAC, provided there are no medical reasons why a vaginal birth would be unsafe.
Many women are surprised to learn that having had one caesarean does not automatically mean every future birth must also be by caesarean. Advances in obstetric care, careful pregnancy monitoring, and appropriate selection of candidates have made VBAC a safe and realistic option for many expectant mothers.
Read: Understanding the Three Trimesters of Pregnancy
Who is a Good Candidate for VBAC?
Whether a VBAC is suitable depends on several individual factors. During your antenatal care, we carefully review your medical history, previous pregnancy, and current pregnancy before discussing your options.
Women are often considered suitable candidates if they have:
- One previous lower segment (horizontal) caesarean section.
- No previous uterine rupture or extensive uterine surgery.
- A healthy singleton pregnancy with the baby in a head-down position.
- No pregnancy complications that would independently require a caesarean birth.
- No contraindications to vaginal delivery, such as placenta praevia.
However, eligibility is never determined by a checklist alone. We also consider the reason for your previous caesarean, your recovery afterwards, your overall health, your baby's growth and wellbeing, and your own preferences regarding birth.
When a Repeat Caesarean May Be Recommended
Although VBAC is appropriate for many women, it is not always the safest option.
A planned repeat caesarean may be recommended if you have:
- A previous classical (vertical) uterine incision.
- Experienced a previous uterine rupture.
- Certain placental conditions, including placenta praevia.
- Multiple previous caesarean sections.
- Certain medical or pregnancy complications that make vaginal birth unsafe.
Even when a repeat caesarean is advised, our aim is always to explain the reasons clearly so you feel fully informed and involved in your care.
What Are the Benefits of a Successful VBAC?
For women who are suitable candidates, a successful VBAC offers several important advantages.
One of the biggest benefits is avoiding major abdominal surgery. Although caesarean sections are very common and generally safe, they remain significant surgical procedures with longer recovery times than uncomplicated vaginal births.
A successful VBAC may also result in:
- A shorter hospital stay.
- Faster physical recovery.
- Less postoperative pain.
- Lower risk of infection.
- Reduced blood loss.
- Earlier return to normal daily activities.
Importantly, avoiding multiple repeat caesarean sections may reduce the likelihood of complications in future pregnancies, including placenta accreta spectrum disorders, surgical adhesions, and more complex abdominal surgery.
For women planning larger families, this can be an important consideration when deciding between VBAC and repeat caesarean birth.
Understanding the Risks
Like every birth option, VBAC also carries risks that should be carefully discussed with your obstetrician.
The complication most commonly discussed is uterine rupture, where the previous caesarean scar separates during labour. While this sounds alarming, it is fortunately uncommon, occurring in approximately 1 in 200 women attempting VBAC with one previous lower segment caesarean section.
Although rare, uterine rupture can become an obstetric emergency requiring immediate caesarean birth. This is why women attempting VBAC are advised to give birth in a hospital with continuous fetal monitoring in labour and access to experienced obstetricians, anaesthetists, operating theatres, and neonatal support, if required.
Other potential considerations include the possibility that labour does not progress as expected, resulting in an unplanned emergency caesarean section.
While an emergency caesarean generally carries slightly greater risks than a planned caesarean, many women still successfully achieve a safe vaginal birth after previous caesarean delivery.
What Factors Improve the Chances of a Successful VBAC?
One of the most encouraging aspects of VBAC is that success rates are generally high when women are appropriately selected.
Overall, around 70-75% of women who attempt VBAC will successfully give birth vaginally, with success rates often even higher in women who have previously had a vaginal birth.
Several factors can increase the likelihood of success, including:
- Going into labour naturally.
- Having previously delivered vaginally.
- Having a healthy pregnancy without major complications.
- Maintaining a healthy weight during pregnancy.
- Having a previous caesarean for reasons that are unlikely to recur, such as a breech baby.
- Waiting 12-18 months between pregnancies
Conversely, factors such as obesity, diabetes, or a previous caesarean due to labour not progressing may reduce the likelihood of successful VBAC, although they do not necessarily rule it out.
Each woman's circumstances are unique, which is why individual assessment is so important.
How We Monitor Labour During a VBAC
Women planning a VBAC receive particularly careful monitoring throughout labour.
Continuous fetal heart rate monitoring is generally recommended because changes in your baby's heart rate can sometimes be one of the earliest signs that additional assessment is needed.
Throughout labour we also monitor:
- The progress of labour.
- Maternal observations, including pulse and blood pressure.
- Pain levels and comfort.
- Contraction pattern.
- Any signs that suggest labour is not progressing safely.
Having experienced obstetric, midwifery and anaesthetic teams immediately available provides reassurance that, should circumstances change, prompt intervention can be provided without delay.
For many women, this close monitoring offers confidence rather than concern, allowing them to focus on labour knowing that both mother and baby are being carefully observed.
Read: Writing a Birth Plan - What to Include and How to Stay Flexible
Emotional Considerations Matter Too
For many women, the decision between a VBAC and a repeat caesarean is influenced by more than clinical factors alone.
Some women hope to experience labour and vaginal birth after an unexpected emergency caesarean during a previous pregnancy. Others may value the predictability of a planned caesarean or have concerns about attempting labour again after a difficult birth experience.
Previous birth trauma, anxiety, family circumstances, recovery from earlier deliveries, childcare responsibilities, and personal preferences all play an important role in decision-making.
There is no universally "correct" choice. What matters most is that your decision is based on accurate information, thoughtful discussion, and a clear understanding of your own priorities.
The Importance of Personalised Obstetric Care
Choosing between a VBAC and a repeat caesarean is not simply about statistics - it is about finding the safest and most appropriate option for you as an individual.
At Obstetric Care, we take time to understand your previous birth experience, your current pregnancy, and your hopes for this delivery. Throughout your antenatal care, we carefully assess your pregnancy, monitor your baby's wellbeing, and provide honest, balanced advice based on the latest evidence and UK clinical guidance.
Our aim is never to steer you towards one particular mode of birth. Instead, we ensure you have all the information you need to make a confident, informed decision, knowing that you will receive expert care and support whichever path you choose.
Read: The Importance of Fetal Scanning in Modern Maternity Care
Making the Right Decision for You
Every pregnancy tells a different story, and your birth plan should reflect your individual circumstances rather than someone else's experience.
Whether you decide to pursue a vaginal birth after caesarean or choose a planned repeat caesarean section, the priority is always a healthy mother, a healthy baby, and a positive birth experience. With expert obstetric care, careful planning, and ongoing support throughout your pregnancy, both options can offer safe and rewarding outcomes.
If you have previously had a caesarean section and would like to explore your birth options in more detail, our experienced obstetric team is here to answer your questions, discuss the latest evidence, and help you make the decision that feels right for you and your growing family.
For more information on the birthing options available please see the Royal College of Obstetricians leaflet "Birth options after previous caesarean section".