In most cases, after having one previous C-section, you can choose whether you’d like a vaginal birth after caesarean (VBAC) or an elective repeat caesarean section (ERCS). If you are fit and healthy, both are safe choices with very few risks.
This decision is up to you, but you might be advised one way or another based on what happened during your previous birth or births and your current medical situation.
Overall, about three out of four women (72-75%) who have a straightforward pregnancy and who go into labour will give birth vaginally after one previous C-section. Your chances go up to about nine out of ten (87-90%) if you have had a previous vaginal birth, either before or after your caesarean delivery.
The pros of a VBAC:
- You’re more likely to have uncomplicated births in the future. The risks of a C-section increase each time you have one, so it’s worth considering how many babies you’d like to have in the future.
- You’re more likely to have uncomplicated pregnancies in the future. You’re more likely, for example, to experience placenta praevia (when the placenta implants over the site of the scar) and placenta accrete (when the placenta becomes firmly stuck to the womb) if you’ve had several C-sections.
- You’re likely to have a shorter stay in hospital post-birth as well as a shorter recovery period as walking around, lifting your baby, driving and other physical activities can be difficult after a C-section.
- You’ll avoid major abdominal surgery and the risks that come with that, e.g. infection, blood clots, and blood transfusions.
- Your baby is less likely to have initial breathing problems than if you were to have a C-section.
The cons of a VBAC:
- The greatest risk for women who plan a VBAC is that they may need to have an emergency C-section, which carries more risks than a planned C-section, such as bleeding, infection, and rupture of the womb. About 25% of women who attempt a VBAC end up delivering via C-section, which is only slightly higher than if you were labouring the first time, when the chance of an emergency C-section is 20%.
- You may need an assisted vaginal birth using either forceps or ventouse, which comes with its own risks, including a higher likelihood that you’ll experience a third or fourth degree tear.
- If you had a previous traumatic labour that ended up in an emergency C-section, you may feel especially worried about the idea of attempting another vaginal birth. Remember that not all risks are to your physical health, and that protecting your mental health is just as important.
You’re more likely to have a successful VBAC if:
- You have had a previous successful vaginal birth.
- Your labour starts naturally, particularly before your due date.
- Your body mass index at the start of your pregnancy is lower than 30.
- Your baby’s birth weight is predicted to be lower than 4kg.
- You’re under 40.
- Your previous caesarean section was not following a failed induction of labour.
A VBAC is an option in most cases, but you might be advised against it if:
- You have had three or more previous caesareans.
- Your uterus has ruptured during a previous labour.
- Your previous caesarean was ‘classical’, which means your doctor made a vertical cut rather than a horizontal cut.
- It is less than 12 months between your last caesarean section and your due date, as this increases the risk of rupture of the womb.
- You have other pregnancy complications that require a planned C-section.
If you do decide you’d like to go with a VBAC, you might be wondering what specific birth options will be available for you.
For example, if you’d like a water birth then in most cases there’s no reason why you wouldn’t be able to have one, particularly as you and your baby can still be monitored through underwater monitoring equipment.
On the other hand, you will probably be advised not to have a home birth if you’ve previously had a C-section.
And finally, if you don’t go into labour by 41 weeks, you’ll have an appointment with your hospital where you can discuss the best move to make next.
You’ll need to decide whether you’d like a VBAC or an ERCS by 36 weeks pregnant, which gives you plenty of time to make your decision. It’s a good idea to discuss how you’re feeling about each option with loved ones and your health professionals, but remember that in the end, you should go with what you feel most comfortable with.