If you had a caesarean birth in the past, it does not mean you will need a caesarean for future births if you become pregnant again.
Many women go on to have a vaginal delivery on their next baby. This is called a vaginal birth after caesarean (VBAC).
Your obstetrician or midwife may advise you to have another caesarean. Or you may choose to have one. This is sometimes called an elective repeat caesarean section (ERCS).
This page covers the risks and benefits for:
- vaginal birth after caesarean
- elective repeat caesarean section
It's recommended that you wait at least 6 months before getting pregnant again.
Talk about your options
Talk to your obstetrician or midwife about your options for birth.
Tell them about:
- how you felt about previous births
- your caesarean birth - why you had it, the type of incision (cut) made and if there were any complications
- any previous vaginal births
- your current pregnancy - including your birth plan and any complications you’ve had
- plans for future pregnancies
Your obstetrician or midwife will consider your options and help you decide about the birth.
Vaginal birth after caesarean (VBAC)
There are 2 types of vaginal birth:
- a straightforward vaginal birth
- an assisted vaginal birth
An assisted vaginal birth is when a ventouse (vacuum cup) or forceps is used to help deliver your baby.
Benefits of a vaginal birth after caesarean
There are fewer risks with a vaginal birth than with an elective caesarean birth.
There is also a:
- better chance of vaginal births in the future
- quicker recovery with less abdominal pain
- shorter stay in the hospital
- better chance of skin-to-skin contact with your baby
- higher chance of breastfeeding successfully
Your baby is also less likely to have breathing problems in the first few hours of life.
How likely a vaginal birth is after a caesarean
If you had 1 caesarean birth, you are more likely to be able to have a vaginal birth.
After 1 caesarean, about 3 in 4 mothers have a vaginal birth.
After 2 caesareans, most births are by caesarean.
Talk to your obstetrician if you would like to try for a vaginal birth following 2 caesarean births. They will explain the risks, benefits and chances of success. If you go into labour naturally, you have about a 7 in 10 chance of a vaginal birth.
A vaginal birth may be less likely if:
- you have never had a vaginal birth
- labour needs to be induced
- labour does not progress and you need a caesarean section - usually due to the position of the baby in your womb
- your body mass index was over 30 at your booking visit
When a vaginal birth is unlikely
Your obstetrician or midwife will not recommend a vaginal birth if:
- your womb ruptured (tore) during a previous labour
- you had a high or classical incision (cut) to your womb
- you had 3 or more previous caesareans
Having more than 3 caesarean sections can increase your risk of complications. Scar tissue can make giving birth more difficult.
Risks of a vaginal birth
In general, a vaginal birth is very safe for you and your baby. But there are some risks. Your obstetrician or midwife will explain these.
You may be at risk of having:
- an emergency caesarean birth
- a blood transfusion
- scar weakness or rupture
Emergency caesarean birth
Emergency caesareans are needed in about 1 in 4 planned vaginal births after caesarean.
For first-time labours, an emergency caesarean is needed in about 1 in 5 births.
You might have an emergency caesarean if:
- labour is not progressing
- the baby needs to be born quickly
Blood transfusion
You may need a blood transfusion with a vaginal birth after caesarean. The risk of this is higher than with an elective caesarean birth.
Scar weakness or rupture
There is a small chance the scar from your caesarean could rupture (open) during labour. This happens for about 1 in 200 women who are trying for a vaginal birth. The risk is higher if your labour is induced.
If your midwife or obstetrician thinks your scar may rupture, you will need to have a caesarean birth.
Risks to your baby
The risks to your baby are small. They include the risk of death or brain damage.
The risk is about 2 in 1,000 births, similar to the risk for first-time labour.
Going into labour
Your midwife or obstetrician will recommend a hospital birth. Contact your hospital as soon as you think you are going into labour or your waters break.
When you are in labour, your midwife will encourage continuous monitoring of your baby’s heartbeat.
Overdue pregnancy
If you have not gone into labour by 41 weeks, you can discuss your options with your obstetrician.
You may be able to wait for labour to start naturally.
Other options are induction of labour or an elective caesarean birth. There is a higher risk of your scar rupturing (opening) if your labour is induced.
Elective repeat caesarean section (ERCS)
An elective repeat caesarean section (ERCS) is a planned caesarean birth.
The date is usually arranged for 39 to 40 weeks of pregnancy. Sometimes there is a reason to have an earlier date.
Labour sometimes starts before the planned date.
Benefits of a repeat caesarean
There are benefits associated with an elective caesarean which include:
- less risk of scar rupture
- no tear in your perineum (the area between your vagina and anus)
- none of the risks of labour that can affect your baby
Risks of a repeat caesarean
The risks of a repeat caesarean are mainly the same as the risks for a first caesarean birth.
But the surgery can be more difficult than the first. This is because you may have scarring in your abdomen (tummy) from the previous surgery.
There is an increased chance of having scar tissue if you have more than 1 caesarean.
It takes longer to recover from a caesarean birth than for a vaginal birth.
Placenta risks
If you have a scar in the womb, there's an increased risk you'll have a very low placenta in a future pregnancy. This is called placenta praevia.
There is also an increased risk of placenta accreta. This is when the placenta grows into the muscle of the womb.
Both of these conditions can lead to excessive bleeding. They can make the placenta difficult to remove during the delivery. In some cases, you might need a hysterectomy (removal of the womb) to remove the placenta. The risk increases with the number of caesareans you have had.
If you are diagnosed with placenta accreta during your pregnancy, you may have a caesarean birth about a month before your due date.
Your baby is likely to need care in a special baby care unit (SBCU). You may need blood transfusions. You may receive some of your care in an intensive care unit (ICU).
You'll have a scan in the second or third trimester to check the position of the placenta.
Other risks
Babies born by elective casearean may have a small risk of breathing problems when they are born.
Risks after more than 3 caesarean sections
Having more than 3 caesarean births can lead to complications. These may include damage to your bowel or bladder. In rare cases, there can be damage to your ureter (the tube connecting your kidney to your bladder).
You may have a higher risk of bleeding. If you have severe bleeding, you might need a blood transfusion or in rare cases a hysterectomy (removal of your womb).
Risks of having a caesarean birth
Going into labour before a repeat caesarean
In about 1 in 10 planned caesareans, labour starts before the planned date. If you go into labour, contact the hospital as soon as possible.
You may need a vaginal examination to see how the labour is progressing. In most cases, you can still have a caesarean birth.
But if labour is advanced, it may be safer to continue with a vaginal birth. Your midwife or obstetrician will discuss this with you.
