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Birth options after a caesarean

If you have had a caesarean birth in the past, this does not always mean that you will need a caesarean birth for future pregnancies.

Talk to your obstetrician or midwife about the options for you.

Your options may include:

If you're fit and healthy, both are safe but with different risks and benefits.

Talk about your options

Talk to your obstetrician or midwife about your options and how you felt about previous births.

They will ask you about:

  • your previous caesarean birth - the type of cut used, and the reason for the caesarean and any complications
  • any previous vaginal births
  • your current pregnancy and any complications
  • your plans for future pregnancies

Your obstetrician or midwife will consider your wishes and your chances of having a successful vaginal birth.

Vaginal birth after caesarean (VBAC)

The following types of delivery are used in a VBAC:

Benefits of a VBAC

You are at less risk if you have a successful VBAC than an elective caesarean birth.

You are likely to have a:

Your baby is also less likely to have breathing problems in the first few hours of life.

Chances of having a successful VBAC

If you have had only 1 previous caesarean you are more likely to have a successful VBAC. About 3 in 4 mothers who have 1 previous caesarean have a successful VBAC.

If you have had a vaginal birth before, the chances of a successful VBAC increase to 9 in 10.

After 2 previous caesareans, most births are by caesarean.

If you want to see if you can have a vaginal birth after 2 previous caesareans, talk with your obstetrician. They will tell you about the risks, benefits and chances of success. If you go into labour naturally, the chances of a successful VBAC are around 7 in 10.

The chances of a successful VBAC may be less likely if:

  • you have never had a vaginal birth
  • your labour needs to be induced
  • your labour did not progress and you needed a caesarean section, usually because of your baby’s position in your womb
  • your body mass index (BMI) was over 30 at your booking visit (the first visit at the maternity unit or hospital)

Reasons you cannot have a VBAC

Your obstetrician or midwife will not recommend a VBAC 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

Risks of a VBAC

In general, a VBAC is very safe for you and your baby. Your obstetrician or midwife will explain the risks.

They will explain the chances and risks of having a VBAC compared to the risks of having a caesarean birth.

You are more likely to be at risk when a trial of labour is unsuccessful.

Emergency caesarean birth

You may need an emergency caesarean birth during your labour. An emergency caesarean is needed in about 25 of every 100 VBAC births.

For first-time labours, an emergency caesarean is needed in around 20 in 100 births.

Reasons for an emergency caesarean birth can include:

  • labour slowing down
  • concerns for your baby’s wellbeing

Blood transfusion

If the VBAC is unsuccessful, the risk of you needing a blood transfusion is higher than with an elective caesarean birth.

Scar weakness or rupture

There is a small chance that your scar could weaken and rupture (open) during labour. This happens for about 1 in 200 women who have a trial of labour after a caesarean section.

Having your labour induced increases the chances.

If your midwife or obstetrician thinks your scar may rupture, you will need 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 1000 births, the same as for first-time labour.

Going into labour

Your midwife or obstetrician will recommend a hospital birth.

If you're planning a VBAC, 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 after discussing your choices.

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 in the last week of your pregnancy. Sometimes there is a reason to have an earlier date.

The safest time to deliver babies by elective caesarean is at 39 to 40 weeks of pregnancy. But in around 1 in 10 planned caesareans, labour starts before the planned date.

Benefits of ERCS

There is a smaller risk of scar rupture when you have an ERCS compared to vaginal birth. This happens in about 1 in 1,000 planned caesarean births.

You will also avoid the risks of having a tear in your perineum (the area between your vagina and your anus).

Both planned ERCS and VBAC are very safe for your baby. ERCS avoids the very rare risks of harm to your baby in labour.

Risks of ERCS$

Recovering from a caesarean birth takes longer than for a vaginal birth.

The general risks of a caesarean birth are the same for ERCS.

But the surgery can be more difficult than the 1st caesarean. This is because there is scarring inside your tummy from the previous surgery.

After 2 caesareans, you will likely need planned caesareans in future pregnancies. This can increase the chance of scar tissue forming.

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 you'll have a placenta which can get stuck in the muscle of the womb. This is called placenta accreta. Both of these conditions can lead to excessive bleeding.

These conditions make the placenta difficult to remove during the delivery. There can be excessive bleeding. In some cases, a hysterectomy (removal of the womb) might be needed to remove the placenta. The risk increases with the number of previous caesareans you have had.

Going into labour before an ERCS

In around 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 you are in advanced labour, continuing with a vaginal birth may be safer. Your midwife or obstetrician will discuss this with you.

Shared decision-making

It is important to have a discussion with your midwife and obstetrician about your options if you had a previous caesarean section. This allows you to make a shared decision about the options available to you.

Page last reviewed: 11 November 2021
Next review due: 11 November 2024

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This project has received funding from the Government of Ireland’s Sláintecare Integration Fund 2019 under Grant Agreement Number 8.