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). 

Vaginal birth after caesarean (VBAC) 

1. Where can I get more information on VBAC?

2. Who will support me in asking for a VBAC?

3. Can I have a water birth after caesarean?

4. Can I have a home birth after caesarean?

5. What happens if I go over the due date?  Can I be induced or do I have to have a caesarean?

6. Will I need any special care in labour if I have a VBAC?

7. If I decide to have a VBAC, how will the baby be monitored during labour?

8. What pain relief can I have for a vaginal birth after caesarean?

9. How long could my labour last if I opt for VBAC?

10. How long can I push in labour before I would be advised to have a caesarean?

1. Where can I get more information on VBAC?

AIMS (Association for Improvements in the Maternity Services) has published a booklet on vaginal birth after caesarean written by Jenny Lesley in 2004. 
”This booklet aims to provide information about choices, suggest ways in which a vaginal birth after caesarean can be made more likely and inform women about their rights and where to find support. Women's experiences are an important element of this book.”

The book can be found in the 'publications' section of the AIMS website (www.aims.org.uk) and purchased for a small fee.

2. Who will support me in asking for a VBAC?

Your obstetrician will support your decision as long as he or she regards it as medically appropriate. Sometimes, obstetricians and midwives may have different views on how advisable it is for an individual woman to attempt vaginal birth. Your midwife should support you to plan and do all she can to help you achieve the birth that you want.  

If you find that the health professionals offering care do not support your wishes, you can contact the Head of Midwifery at your local trust who is responsible for managing the midwifery care you have. You can also contact the Nursing and Midwifery Council who will be able to help you identify the Local Supervising Authority Midwifery Officer (LSAMO) for your area. The LSAMO will give you information about who you should contact locally as she is responsible for ensuring that midwives offer the correct standards of midwifery care. 

3. Can I have a water birth after caesarean?

Typically, women who have had a previous caesarean will not be offered the option of a water birth. As labour after a caesarean carries greater risks than after a vaginal birth, clinical guidelines recommend for women who attempt VBAC to have Electronic Fetal Monitoring (EFM) and this cannot be done whilst using a pool. However, it may be possible to use the pool for relaxation in the very early stages of labour.

4. Can I have a home birth after caesarean?

Doctors will usually discourage women from attempting a home birth due to the greater risks associated with going through labour after a previous caesarean (specifically, the risk of unterine rupture). Clinical guidelines recommend that women who attempt VBAC should labour in a hospital unit which has immediate access to caesarean and on-site blood transfusion services. However, a few women make a conscious decision to attempt VBAC outside the hospital environment. Women's experiences of VBAC at home (sometimes also referred to as HBAC) can be found on the following websites: www.caesarean.org.uk/FAQ.html#VBAC

Further advice for women considering a home birth after caesarean can be found at: www.homebirth.org.uk

A booklet on home birth in general (not specifically after caesarean) can be purchased from the AIMS website (www.aims.org.uk).

5. What happens if I go over the due date?  Can I be induced or do I have to have a caesarean?

Some women who are planning to have a VBAC do not want to be induced and would rather have a planned caesarean instead if they did not go into labour spontaneously. Clinical guidelines state that women who have had a previous caesarean can be offered induction of labour, but should be aware that induction increases the likelihood of uterine rupture from around 35 in 10,000 women attempting VBAC to between 80 in 10,000 women if using induction drugs not containing prostaglandins. The risk increases to 240 in 10,000 women if women are induced using prostaglandins. If a woman decides to be induced, she should have access to electronic fetal monitoring and immediate access to caesarean. Talk about your preferences regarding induction at your consultant's appointment.

6. Will I need any special care in labour if I have a VBAC? 

As going through labour after a previous caesarean carries greater risks than after a vaginal birth, clinical guidelines recommend that women who attempt VBAC should be cared for in a hospital unit where there is immediate access to caesarean and on-site blood transfusion services. They also recommend the use of Electronic Fetal Monitoring, as a sudden change in the baby's heart rate can act as an early warning sign for complications that might otherwise go unnoticed.

7. If I decide to have a VBAC, how will the baby be monitored during labour?

Clinical guidelines recommend that women who have had a previous caesarean should have electronic fetal monitoring (EFM) during labour. EFM can help to spot complications that may otherwise go unnoticed. However, continuous EFM reduces the mother's mobility and can make it harder to change positions easily, so it can make labour more uncomfortable. Try to talk about your choices for monitoring in advance. 

8. What pain relief can I have for a vaginal birth after caesarean?

A booklet Pain Relief during Labour published by the Obstetric Anaesthetists' Association provides general information about various forms of pain relief and can be downloaded at: www.oaa-anaes.ac.uk/content.asp?ContentID=115

Last reviewed November 2010.