A vaginal birth after a caesarean section (VBAC) is often possible and safe. However, it is still important to be fully aware of the risks and benefits so you can make informed decisions, both for your birth preferences and in special circumstances.

Why are some women concerned about having a VBAC?

It can feel scary to consider vaginal birth if a caesarean section has been your sole experience. You may have been told by a friend that she had to have a caesarean birth with her second child because she had one with the first. This can be true, depending on the reason surgery was necessary in the first instance and how the incision was made. A previous caesarean makes a second more likely statistically. However, even if you’ve had several caesareans, a safe vaginal birth can be entirely possible and may even be advisable, given that caesarean surgery becomes more complicated the more times you have it done. While no safe number of repeat caesareans has been established, for example, we know that women who have multiple caesareans are at greater risk of placental problems. It’s extremely important to speak to your doctor and midwife about whether a VBAC is right for you. Your age, previous pregnancy experience, general health, and how many children you’d like to have are all factors to consider.

One of the biggest medical concerns with a VBAC is the risk of uterine rupture (often where the caesarean incision was made), which increases after every C-section and has rare but life-threatening consequences. The placement of your caesarean scar can increase your risk of it opening. Other elements of your pregnancy profile can also increase your risk of uterine rupture, including advanced maternal age, having a big baby, going overdue, and being induced. On the other hand, the overall risk of uterine rupture is rare—1 in 1,146 pregnancies. With every VBAC you have, your risk of uterine rupture decreases, though it will always remain an important concern in any pregnancy.

Some supporters of VBACs point to the normalisation of caesarean birth combined with a sometimes frightening portrayal of vaginal birth perpetuated by the media heightens maternal concerns unnecessarily. Even if you are concerned, it’s important to remember that vaginal birth is the natural norm and usually nothing like what you’ve seen on screen. While VBACs have not yet had a celebrity birthing trend moment, it’s interesting to note that the late Queen Elizabeth II had three of them.

What are the chances of having a successful VBAC?

The chances of a VBAC with no intervention depend on your pregnancy and where you plan to give birth, as well as the individual circumstances surrounding your birth. If you are considered high-risk and giving birth in a labour ward, intervention is more likely. There are things you can do to increase your chances of success. All the usual lifestyle advice—eating well, avoiding caffeine and alcohol, taking your supplements, exercising, practicing safe sex, managing chronic conditions, and attending all your midwife appointments—makes you a better VBAC candidate. A healthy mindset about the experience and learning relaxation strategies like hypnobirthing can reduce your risk of intervention and keep you feeling confident as your VBAC approaches. Successful VBAC stories often include advice to believe in yourself but remember that if it doesn’t work out, you can still have a safe and successful caesarean birth experience. Numbers wise, your chances of success are between 63.3 and 72-75% if you’ve never had a vaginal birth before, according to the British Journal of Midwifery. This increases to 85–90% for women who have given birth vaginally before, according to the Royal College of Obstetricians and Gynaecologists. It’s important to remember your individual health and pregnancy circumstances will affect how accurately these percentage ranges apply to your case. It is likely that your doctor will be able to give you an idea of how successful your VBAC will be based on the specifics of your pregnancy.

Who shouldn’t have a VBAC?

A woman who has had a uterine rupture before is not usually considered a candidate for a VBAC. If you’ve had a “classical caesarean,” for which the incision is vertical and high, you are at especially high risk for uterine rupture and will usually be advised against a VBAC. If there’s been a very brief interval (fewer than 19 months), between your current and previous pregnancies, your doctor will usually advise delivery via c-section. An elective caesarean may be recommended to you for other reasons related to your health and pregnancy, such as a low-lying placenta.

Why might a VBAC fail?

A VBAC can fail for a wide variety of reasons. If you’ve never had a vaginal birth before, your VBAC is statistically more likely to fail. If your baby is big for gestational age or premature, if you’ve had an induction, or if you’ve had pre-eclampsia or another condition in pregnancy that made you high-risk, your VBAC is likely to fail. It is important to remember that if things do not go according to your preferences, a failed VBAC can still have a good and completely successful outcome through caesarean section.

Can I give birth at home if I’m trying to avoid intervention during my VBAC?

Planning a VBAC at home makes you more likely to successfully give birth vaginally. No one can legally prevent you from giving birth at home if you really want to, but your healthcare team may advise against it, as you won't have fast access to a surgeon, operating theatre, or blood transfusion facilities in the event your previous caesarean incision opens. ACOG advises against home birth after a caesarean section. It’s important to listen to your doctor’s advice and ask as many questions as you need to so you can make the right decision on your birth location. Home birth can be an incredibly empowering and life-affirming experience. In the UK, it will happen with two highly-experienced midwives looking after you with the option to transfer to a hospital if there are complications. For more on planning a home birth, check out Unii’s medically reviewed article or Preconception video episode. However, more often than not, giving birth in an environment that will allow you to have an emergency caesarean if necessary will be recommended to you for a VBAC, so try to stay open-minded.

How do I plan for a VBAC?

You and your doctor or midwife can make a plan for your vaginal birth before you write your birth preferences or plan. This process can help you feel more confident about your VBAC and help you envisage and know what you want in a variety of circumstances, including those in which intervention is required. It’s important to involve your birth partner, as you may not feel able to advocate for yourself when things get started.

For more advice on taking care of yourself in pregnancy, labour, and birth, check out Unii’s Antenatal Classes, with prenatal video episodes taught by senior NHS midwives, an award-winning obstetrician and gynaecologist, and six other leading healthcare experts. Only at unii.com.

For more information on having a healthy pregnancy, check out Unii’s Pregnancy Journey video course with Dr. Shree Datta. To learn about having a smoother delivery, watch our Giving Birth Journey with Dr. Keith Duncan.

What do I need to know about VBAC?