If you have had a caesarean section (C-section) before, your midwife will talk to you about your options for this pregnancy. This handout aims to help you think and talk about your decision with your midwife, your partner and your family, and friends.
What are my options when giving birth after a previous C-section?
You will have the choice of planning either:
| Vaginal birth after caesarean section (VBAC) | Repeat caesarean section (C-section) |
|---|---|
| VBAC is a safe choice for most people who have had a C-section. Many who have had a C-section in the past will still be able to give birth vaginally. Some who plan VBAC will end up having a C-section again. | You may prefer to have another C-section. For some, a planned C-section may be a safer option. |
What are my chances of having a VBAC?
Most VBACs happen as planned.
It’s hard to guess your chance of having a VBAC. Some things about your own health history and previous birth experience(s) may make it more or less likely that you will give birth vaginally.
Your chances of having a VBAC are INCREASED if:
- You have had a vaginal birth before.
- The reason for your last C-section is not a factor this time (for example, your last C-section happened because your baby was in a feet-first (breech) position, and your baby’s head is down this time).
Your chances of having a VBAC are DECREASED if:
- You are given drugs to induce (start) or augment (strengthen or speed up) your labour.
- Your BMI is over 25 – 30.
- You are 35 years of age or older.
You may have a higher or lower chance of having a VBAC if one or more of these factors apply to you. But there is no way to know for certain whether or not you will have a VBAC. Research shows that even if your chances of having a VBAC are decreased, you still have a greater than 50% chance of having a vaginal birth.
What are some of the differences between VBAC and C-section?
Studies tell us that both VBAC and planned C-section are very safe. However, having a baby always involves some risk of complications, no matter what kind of birth you have.
Some risks of VBAC
Uterine rupture:
- Uterine rupture occurs when the wall of the uterus splits during pregnancy or labour. This usually happens along the scar of a previous C-section.
- Uterine rupture requires emergency surgery.
Uterine rupture happens in about 0.5% of ALL VBAC labours. This means that one uterine rupture would be expected to occur for every 200 people who plan to have a VBAC.
Most birthing parents and babies will recover completely after uterine rupture. On rare occasions, uterine rupture can have serious effects:
- birthing parent: excessive bleeding or removal of the uterus (hysterectomy)
- baby: brain damage or death
These sorts of results occur in fewer than 5% of cases of rupture. Because rupture occurs so rarely, the chances that a VBAC will lead to problems for you or your baby are very low.
There is no way to know for certain who will have a uterine rupture. Your chances may be higher if:
- you had your last C-section less than two years ago, or
- you are given drugs to induce (start) or augment (strengthen or speed up) your labour this time.
Having one of these factors doesn’t mean it is unsafe to plan a VBAC – it just means that the likelihood of having a uterine rupture is slightly higher, but still low.
Having an emergency C-section:
Even if you plan VBAC, you may need to have a C-section. This happens to about 1 in 4 who plan VBAC. Having a C-section after labour has begun is associated with more risks (such as uterine infection) than a C-section before labour.
Some risks of repeat C-section
Problems related to surgery:
- Like any major surgery, repeat C-section can result in surgery-related problems: fever, infection, injuries to the bowel or bladder, or blood clots.
Neonatal breathing difficulties:
- Vaginal birth helps squeeze fluid from your baby’s lungs. That’s why babies born by C-section are more likely to have trouble breathing compared to babies who are born vaginally.
- Midwives and hospitals are well prepared to deal with babies’ breathing problems. Most of the time, these problems are mild and babies quickly recover.
- Breathing problems may mean your baby requires admission to a special nursery or newborn intensive care unit (NICU) for observation or treatment. This may mean that you are separated from your baby.
Problems with the placenta in future pregnancies:
- Scars from C-sections can cause problems with how the placenta attaches itself to the uterus in future pregnancies (placenta previa and placenta accreta). These problems can cause serious bleeding and in rare occasions may cause death.
- The risk of placenta problems increases with each additional C-section.
How can I decide what’s best for me?
You may find it helpful to think about some of the common reasons others might choose each option. Like any aspect of childbirth, VBAC and repeat C-section each have risks. They also have their own benefits. Thinking about what benefits and risks matter most to YOU can help you decide whether to plan a VBAC or a repeat C-section.
Who is helping you make this decision?
Are there other people in your life whose support or advice is important to you? Your partner? Family? Friends?
You may find it helpful to share this information with them as it may help them understand the options available to you, and get them thinking about what benefits and risks that THEY think are most important. This can also be helpful if you have already made a decision and you need them to understand why you have chosen one option over another.
