The information in this section was compiled by Kristina Bennert with clinical advice from Rona McCandlish (Midwife and Epidemiologist) and Roshni Patel (Specialist Registrar in Obstetrics & Gynaecology). 

Deciding how to give birth after caesarean 

1. After having had a caesarean how likely am I to have a vaginal birth? 

2. Will the same problem that I had with my 1st birth happen again?

3. Now that I have had a caesarean if I have another baby how do the risks of having a repeat caesarean compare with the risks of having a vaginal birth?

4. Which method of giving birth is safer for the baby?

5. Which method of giving birth is safer for the mother?

6. Can I have a caesarean, without a medical reason?

7. How many caesareans can I have?

8. If my next baby is in breech position, can I have a vaginal birth?

9. If I have twins in my next pregnancy, can I have a vaginal birth?

10. Can I have a vaginal birth after I have had two or more caesareans? 

1. After a caesarean, how likely am I to have a vaginal birth? 

About two thirds of women who attempt VBAC will have a vaginal birth. Out of these, about one in three will have a birth assisted by ventouse (suction cup) or forceps. Rates of vaginal birth differ between hospitals and are influenced by a number of factors. Birthchoice UK provides statistics about the caesarean section, induction and instrumental delivery rates of UK hospitals: www.birthchoiceuk.com

The likelihood for an individual woman of having a vaginal birth will depend on a number of factors including her medical history and the reasons for her previous caesarean. If you opt into care with an obstetric consultant s/he will be able to tell you how likely it is that previous problems will recur. Your GP and midwife should also be able to discuss this with you. Overall, the likelihood of having a vaginal birth after caesarean is greater for women who have had one or previous vaginal deliveries and for those whose previous caesarean was for a breech baby. The likelihood to have a vaginal birth is lower for women who had their previous caesarean due to a small pelvis or women who had to be induced to start their labour.

2. Will the same problem that I had with my 1st birth happen again?

Many women worry that the complications that lead to their first caesarean might happen again. The only way to find out about the chances of problems recurring is to discuss the reasons for your previous caesarean with a consultant. You should have had a debrief after your operation to clarify this. You can also ask to see the notes from your previous caesarean, though as they are written for other health professionals, be aware that they might be difficult to understand.

3. Now that I have had a caesarean, if I have another baby, how do the risks of having a repeat caesarean compare with the risks of having a vaginal birth?

The risks and benefits of vaginal birth after caesarean compared with repeat planned caesarean are uncertain. Clinical guidelines therefore recommend that the decision about how to give birth after a previous caesarean should take into consideration the mother's preferences and values. Women should have the opportunity to discuss pros and cons of different ways of giving birth with health professionals. The DiAMOND information program gives detailed statistical information about a range of health outcomes for the mother and baby for vaginal birth, planned caesarean and emergency caesarean to support women in making an informed decision: www.computing.dundee.ac.uk/acstaff/cjones/diamond/information.html

4. Which method of giving birth is safer for the baby?

Many women assume that because planned caesarean is usually a quicker method of birth than vaginal delivery, having a caesarean is safer for the baby. However, there is no medical evidence that VBAC or planned caesarean has better outcomes for the baby's health - they simply carry slightly different risks. For further information and a comparison of risks to the baby in vaginal birth, planned caesarean and emergency caesarean, please see the DiAMOND information program: www.computing.dundee.ac.uk/acstaff/cjones/diamond/information.html

5. Which method of giving birth is safer for the mother?

Vaginal birth carries less risk for the mother than caesarean birth. However, about one third of women who attempt vaginal birth after a previous caesarean will need to have an emergency caesarean, and an emergency caesarean carries more risks than a planned caesarean. Because there is a greater degree of uncertainty about the actual outcome with vaginal birth after caesarean, it is at current not possible to say which method of birth is safer for the mother. Both carry slightly different risks and benefits and which option is perceived as safer will depend on women's personal values. (For more information about  the risks and benefits of different ways of giving birth, see www.computing.dundee.ac.uk/acstaff/cjones/diamond/information.html)

6. Can I have a caesarean without a medical reason?

The answer to the question can be found by following the link to www.caesarean.org.uk www.caesarean.org.uk/FAQ.html#requesting

7. How many caesareans can I have?

Answer from caesarean.org: www.caesarean.org.uk/FAQ.html#maxCS

There is no set limit on the number of caesareans that can be carried out on an individual woman. A first caesarean is considered to be a relatively simple operation, but subsequent caesareans are not so easy or predictable, due to the scar tissue that remains from the previous surgeries. Damage to the bladder or bowel may be more difficult to avoid during subsequent surgery and women can be unaware that they have had such damage repaired during a caesarean. The risk of having a hysterectomy (removal of the womb) during the operation also is significantly increased for women who have had two or more caesareans previously. Caesarean hysterectomy is associated with earlier menopause, surgical complications and haemorrhage (bleeding). Women should speak to their consultant about the last caesarean, to check whether there were any specific problems during their last caesarean that might suggest additional risks in their individual case.

8. If my next baby is in breech position, can I have a vaginal birth?

Around 3-4% of pregnancies have a baby in breech position at term. In 2000, a large randomised controlled trial (The Term Breech trial*) involving 2088 women in 26 countries found that caesarean birth was a safer way to deliver a breech baby than vaginal birth. Many hospitals in the UK have since adopted the practice of recommending a caesarean to women with a baby in breech position regardless of their previous medical history. Clinical guidelines state that women with a baby in breech position should be offered EVC (External Cephalic Version, a non-invasive method of turning the baby in the womb) Before an ECV is carried out, the person doing the procedure will use an ultrasound machine to check where the placenta is growing in your womb. Sometimes, the placenta can grow over the neck of the womb and if the placenta is in the wrong place then ECV will not be offered as it would not be safe to try to give birth vaginally.

As caesarean appointments are usually booked several weeks before term, the baby may turn by itself before the due date. If the baby remains in is in breech position at term, obstetricians would usually advise women to have a repeat caesarean.

A booklet on breech birth (not specifically after caesarean) is available to purchase from the AIMS (Association for Improvements in the Maternity Services) website www.aims.org.uk.

Breech Birth - What are my options? Written by Jane Evans, published April 2005.

*Ref: Term Breech Trial Collaborative Group, Lancet 2000; 356: 1375-83

9.  If I have twins in my next pregnancy, can I have a vaginal birth?

A number of studies have suggested that women who are pregnant with twins have a similar likelihood of having a vaginal birth after caesarean than mothers pregnant with just one baby (namely, 65 - 84 %). There does not seem to be an increased risk of uterine rupture. However, if a woman with a twin pregnancy wanted to have a planned caesarean, most consultants would see be likely to see this as reasonable request. 

Some personal experiences of vaginal birth after caesarean with twins can be found at www.homebirth.org.uk/vbactwins.htm

10. Can I have a vaginal birth after I have had two or more caesareans? It is possible to have a vaginal birth after two or more caesareans. Vaginal birth after two caesareans is often referred to as VBAC2. Several studies suggest that the likelihood of having a vaginal birth after two caesareans is not much lower than after just one caesarean. However, the nature of the previous incisions, how well the scar has healed and long ago the last caesarean was performed will influence the likelihood of vaginal birth. Women who have had three or more caesareans are much less likely to have a vaginal birth with their next delivery.  

Further information on vaginal birth after multiple caesareans, compiled by a mother from her own research, can be found at 

Link: www.plus-size-pregnancy.org/CSANDVBAC/vbac_after_2_cs.htm

Last reviewed November 2010.