What is a vaginal birth after caesarean or VBAC?

Birthing mothers who have 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 pick up quickly 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 doctor will recommend a planned caesarean.

Thinking about a VBAC

If you want to try a VBAC, it’s a good idea to choose a doctor or midwife 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 doctor or midwife and going to birth classes. Some hospitals also have information about VBAC. And talking with other birthing mothers who have had caesareans and are planning the births of their next babies might help too.

I wasn’t fazed about the idea of having a vaginal birth after caesarean (VBAC). In fact, I was so looking forward to it that I didn’t let fear enter my mind! The hospital was very much in favour of vaginal birth, and there was no reason why I couldn’t try to have a VBAC.
– Louise, mother of 2, 1 VBAC

VBAC: benefits

The experience of vaginal birth varies a lot among birthing mothers. But vaginal births – including VBACs – also have some common benefits for you and your baby.

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

• recover more quickly from labour and birth
• have shorter hospital stays
• 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 babies and have skin-to-skin contact straight after birth
• have a better chance of starting and continuing to breastfeed their babies
• be less likely to have complications in future pregnancies
• be more physically able to care for their babies (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 time in the special care nursery 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. 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 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 200 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. In very rare cases, birthing mothers need a hysterectomy (removal of the uterus) if they have severe bleeding and there’s a serious risk to their health.

The risk of tearing and its complications is why the doctors and midwives monitor you very closely during VBAC.

VBAC does have a higher likelihood of unplanned (emergency) caesarean. 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 scar. And an unplanned caesarean can have more problems than a planned (elective) caesarean. 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 doctors and midwives, and they’ll deal with any problems that might come up during labour.

Your chances of having a successful VBAC

Your chances of having a successful 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 successful VBAC.

A comfortable and positive birth setting, caregivers and support people can increase your chances of having a vaginal birth.

Continuous support during labour might help you to feel more comfortable and relaxed. This might be support from a familiar midwife, a close support person or a doula.

Going to special VBAC classes is also a good idea, so you know what to expect. You might be able to do some VBAC classes online.

Eating healthy food and keeping active during pregnancy can keep you fit and well, which also boosts your chances.

My doula was fantastic in reminding me of my rights and reinforcing them to my husband who could then talk with the staff. My husband demanded a doctor who would support my decision to try to VBA2C (vaginal birth after two caesareans).
– Noni*, mother of three, one VBAC

Birth centres, homebirth and VBAC

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

Doctors and midwives 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 scar tearing. Some hospitals offer midwife-led care for birthing mothers who’d like to try VBAC.

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

* Not her real name