Your birth options after a previous caesarean birth

Your birth, your choice

If you have any questions or worries, please speak with your doctor or midwife. We are here to support you and provide you with knowledge and information so that you can make the best decision and choices for you, your baby, and your family.

To support your decision making, you can start by asking us three questions:

• What are my options?
• What are the pros and cons of each option for me?
• How do I get support to help me make a decision that is right for me?

If you have any further questions, please do not hesitate to ask us. You can find our contact details at the end of this leaflet or please refer to the telephone numbers provided in your maternity file.

Your birth options

What is VBAC?

VBAC stands for ‘vaginal birth after caesarean’. It is the term used when a woman gives birth vaginally, having had a caesarean birth in the past. Vaginal birth includes straightforward delivery and birth assisted by forceps or kiwi/vacuum cup.

What is an ERCS?

ERCS stands for ‘elective repeat caesarean section’ and refers to a planned caesarean birth after your first caesarean.

You will usually have the operation after 39 weeks of pregnancy. This is because babies born earlier than this by caesarean are more likely to need to be admitted to a special care baby unit for help with their breathing, hence waiting until after 39 weeks when your baby is mature.

What to consider when deciding between a vaginal birth or an elective caesarean birth

You should consider:

• The reason you had your first caesarean birth.
• Whether you have had a previous vaginal birth.
• Whether there were any complications at the time or during your recovery.
• The type of incision (cut) that was made in your uterus (womb).
• How you felt physically and emotionally about your previous birth.
• Whether your current pregnancy has been straightforward or whether there have been any problems or complications and how many more babies you are hoping to have in the future. The risks increase with each caesarean birth, so if you plan to have more babies it may be better to try to avoid another caesarean birth if possible. This is something you can discuss with your midwife and/or doctor.
• After more than one caesarean birth, you should have a detailed discussion with a senior obstetrician about the potential risks, benefits, and your likelihood of having a vaginal birth.

To help you decide, your midwife will invite you to attend birth options clinics if you have requested to have or have previously had a caesarean birth.

If you are having your baby at the Royal Free Hospital, these will be at 28 weeks and 34 to 36 weeks. If you are having your baby at Barnet Hospital, this will be at 28 weeks. An additional appointment may be made at 40-41 weeks if you go past your due date.

Vaginal birth after caesarean (VBAC)

What is the likelihood of me having a vaginal birth?

After one caesarean birth, about three out of four women (75 per cent) with a straightforward pregnancy who go into labour naturally give birth vaginally.

Several factors can increase the likelihood of you having a vaginal birth, including:

• Previous vaginal birth: if you have had a vaginal birth, either before or after your caesarean section, around eight to nine out of 10 women can have another vaginal birth.
• Your labour starting naturally.
• Your body mass index (BMI) at booking being less than 30.

What are the advantages of having a vaginal birth after a previous caesarean birth?

• A vaginal birth after a previous caesarean birth has fewer complications than a planned caesarean birth.
• You will be more likely to have further vaginal births.
• Your recovery will be quicker.
• You may have a shorter time in hospital.
• You are more likely to have immediate skin-to-skin contact with your baby and successfully establish breast feeding.
• You will avoid the risks of an operation.
• Your baby will be less likely to develop breathing problems.

What are the disadvantages?

Overall, serious risks for you and your baby are rare for most women, however we have outlined below some of the possible implications that may occur in a vaginal birth after a previous caesarean birth.

• Up to two out of five women (40 per cent) may need an assisted vaginal birth using a kiwi/vacuum cup or forceps.
• Approximately one in four women (25 per cent) who opt for a vaginal birth may need to have an emergency caesarean birth during labour. This is compared to approximately 20 per cent in women having their first baby, and 11 per cent in women having a previous vaginal birth. An emergency caesarean birth carries more risks than a planned caesarean section. The most common reasons for an emergency caesarean section are if your labour slows and/or if there is a concern for the wellbeing of your baby.
• You have a slightly higher chance (2 per cent versus 1 per cent) of needing a blood transfusion compared with women who choose a planned second caesarean section.
• There is a possibility that the scar on your uterus from your previous caesarean birth may separate or tear. This is a very rare complication and typically occurs in one in 200 mothers who have had one previous caesarean section. This risk increases by two to three times if your labour is induced or if a mother has had more than one previous caesarean birth. If there are warning signs of these complications, your baby will be delivered by emergency caesarean. However, in the rare circumstances when a uterine tear does occur this can have serious impact on the health of mother and baby.
• Serious risk to your baby such as brain injury is higher (eight per 10,000) with a vaginal birth after caesarean compared to less than 1 per 10,000 with a planned caesarean birth.
• Planned vaginal birth after caesarean is associated with a tiny by increased risk of stillbirth after 39 weeks (an additional 10 per 10,000). The rate of stillbirth is the same as if you were labouring for the first time.

When is vaginal birth after caesarean not advisable?

Vaginal birth is normally an option for most women, but it is not advisable when:

• You have had three or more previous caesarean deliveries.
• Your uterus has ruptured during a previous labour.
• You had an incision (cut) on your uterus from your previous caesarean birth involving the upper part of the uterus.
• You have other pregnancy complications that require a planned caesarean birth.

Elective caesarean birth

What are the advantages of an elective caesarean birth?

• There is a smaller risk of uterine scar rupture (one in 1000).
• It avoids the risks of labour and the rare serious risks to your baby are reduced.
• You will know the date of planned birth. However, one in 10 women go into labour before the date of their elective birth.

What are the disadvantages?

• Scar tissue from the previous caesarean may make the operation more difficult and can result in damage to your bowel or bladder. This occurs in less than 1% of repeat caesarean births.
• You can get a wound infection that impairs healing.
• You may need a blood transfusion.
• You have a higher risk of developing a blood clot in your legs or lungs.
• You may have a longer recovery period and will be unable to drive for about six weeks after surgery.
• You are more likely to need a planned caesarean birth in future pregnancies. This increases the possibility of the placenta growing into the scar. This can result in bleeding and may require a hysterectomy.
• Your baby’s skin may be cut at the time of caesarean birth. This happens in 2 out of every 100 babies delivered by caesarean birth. Such cuts when they occur are usually small and will usually heal naturally.
• Breathing problems for your baby are quite common after caesarean birth but are usually short-lasting. Between four to five in 100 babies born by planned caesarean at or after 39 weeks have breathing problems. They may require admission to special care baby unit.

Frequently asked questions