Vaginal birth after caesarean (VBAC)

What is a vaginal birth after caesarean or VBAC?

Birthing mothers who’ve had a caesarean birth are usually able to safely try vaginal birth next time around. This is commonly called vaginal birth after caesarean or VBAC.

A VBAC is generally the same as any other vaginal birth. But one difference is that when you go into labour, midwives and doctors will monitor you more closely than if you hadn’t had a previous caesarean birth. They might use equipment to monitor your health and your baby’s health during labour and birth. This is so they can quickly pick up on any problems.

If everything is fine medically, you should be able to labour and give birth vaginally. But if there are medical reasons for not trying a VBAC, your midwife or doctor will recommend a planned caesarean birth.

Thinking about a VBAC

If you want to try a VBAC, it’s a good idea to choose a midwife or doctor who’ll support your choice. It’s OK if it takes a while to find the health professionals who are right for you.

Your choice of hospital will also be important, because not all hospitals offer VBAC.

You can find out more about VBAC by asking your midwife or doctor and going to antenatal classes. Some hospitals also have extra information about VBAC. And talking with other birthing mothers who’ve had caesareans and are planning the births of their next babies might help too.

VBAC: benefits

Vaginal birth experiences vary a lot among birthing mothers. But vaginal birth – including VBAC – also has some common benefits for birthing mothers and babies.

For example, most birthing mothers who have vaginal births will:

recover more quickly from labour and birth
be less likely to need to go back to hospital in the weeks after birth
have less need for strong pain relief after birth
be more likely to touch and cuddle their baby and have skin-to-skin contact straight after birth
have a better chance of starting and continuing to breastfeed
be less likely to have complications in future pregnancies
be more physically able to care for their baby (and their other children).

Many birthing mothers say they feel well and happy after vaginal birth. Birthing mothers who experience vaginal birth can feel more satisfied with their overall birth experiences.

Also, babies who are born vaginally are less likely to need to go to a special care nursery or neonatal intensive care unit for breathing difficulties or other health concerns.

Babies born vaginally tend to develop stronger immune systems and are less likely to have allergies than babies born by caesarean section. This is thought to be because of hormones released during vaginal birth and the important bacteria babies get through vaginal birth.

VBAC: possible disadvantages

If you have a VBAC, your baby’s heartbeat and your labour contractions will be monitored more closely during labour. You might need to wear special equipment for this. Sometimes the equipment can make it harder to move around during labour or to use water for pain relief.

You also have slightly more risk of the scar in your uterus tearing or rupturing during labour. But this is a very small risk to start with – it happens in only 1 out of 500 birthing mothers having VBACs. The risk of tearing increases slightly with each caesarean you have.

Tearing can happen with little warning, and it can seriously affect you and your baby. Often the tear can be repaired.

The risk of tearing and other rare risks and complications are why your midwives and doctors monitor you very closely during VBAC.

There’s a higher chance of an unplanned (emergency) caesarean birth with VBAC. This might happen if the monitoring shows that your baby is in distress or if your labour is very long, which puts more strain on your caesarean scar. And an unplanned caesarean birth can have more problems than a planned (elective) caesarean birth. These problems include infection and increased bleeding.

If you’re thinking about a VBAC, it might help to know that your baby will be just as safe as if you were giving birth vaginally for the first time. You and your baby will be closely monitored by your midwives and doctors, and they’ll deal with any problems that might come up during labour.

Your chances of having a VBAC

Your chances of having a VBAC depend on a few things, including your health and the reason why you had a caesarean birth previously. If you’ve had a vaginal birth before and you have a healthy, uncomplicated pregnancy, this improves your chances of having a VBAC.

Continuous support during labour might help you to feel more comfortable and relaxed and increase your chances of having a VBAC. This might be support from the midwife or small group of midwives that you’ve seen throughout pregnancy. This kind of support is called ‘midwife-led continuity of care’. It might also be support from a close support person or a doula.

Knowing what to expect can help too, so it’s a good idea to go to special VBAC classes in preparation for birth. You might be able to do these classes online.

Healthy food, healthy weight gain and regular exercise during pregnancy can keep you fit and well. This also boosts your chances of having a VBAC.

In general, a comfortable and positive birth setting, carers and support people can increase your chances of vaginal birth.

Birth centres, homebirth and VBAC

Talk with your midwife or doctor if you’re thinking about VBAC and want to have your baby at a birth centre or have a homebirth.

Midwives and doctors will usually say that a hospital birthing suite is a safer choice. That’s because it’s better to be in a hospital in the unlikely situation of your caesarean scar tearing. Some hospitals offer midwife-led care for birthing mothers having VBACs.

It’s important to discuss your choices with your partner, if you have one, and your midwife or doctor. If you’re still worried after this, you might want to get more than one medical opinion.