Vaginal Birth After Caesarean
INFORMATION FOR PREGNANT WOMEN
This handout provides information for women who have had a previous caesarean section
birth.
Location of uterine scar
There are two main types of uterine incisions (cuts) used for caesarean sections:
1. Lower transverse (side-to-side): This is often called a ‘lower uterine segment
caesarean section’ or ‘LUSCS’ for short. This is the type of caesarean section used
for almost all women, whether the caesarean birth was before or during labour.
2. Vertical (up-and-down) this type of uterine incision made at caesarean section is not
suitable for a future vaginal birth.
Most women will have had a transverse (side-to-side) incision in the lower, thinner part of
the uterus. Knowing what type of caesarean birth you have had is important because only
women who have had a lower transverse caesarean (LUSCS) are suitable for a vaginal
birth in a subsequent pregnancy. It is important to be aware that it is not possible to tell the
type of caesarean section a woman has had simply from her skin incision (scar). Having a
transverse (side-to-side) scar does not necessarily mean that the caesarean was a
LUSCS. It may be necessary for you or your doctor to obtain the operation report from
your previous caesarean to determine what type it was.
Information provided in this handout only applies to women with a lower transverse uterine
incision. If you have another type of uterine incision or are uncertain your doctor will
discuss birth options with you separately.
Type of birth
For women who have had a lower uterine segment caesarean section there are two birth
options in a subsequent pregnancy:
1. Vaginal birth after caesarean section (VBAC)
2. Elective repeat caesarean section
Before making a decision on which method is best, you should consider the chance of a
successful VBAC, the risks and benefits of VBAC or a repeat caesarean and your own
preference and motivation for a vaginal birth.
Midwives and doctors at Barwon Health support the decision of women to attempt a
normal labour and birth (VBAC) in their next pregnancy.
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Success of VBAC
Overall, three out of four women who plan to have a VBAC have a vaginal birth. One out of
four ends up having a caesarean. Women who have had a vaginal birth before their
caesarean are even more likely to have a successful VBAC. It is useful to remember that
one out of five women in their first pregnancy end up having a caesarean birth. This is very
similar to women planning a VBAC.
Advantages of VBAC (compared to a repeat caesarean birth)
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Lower risk of complications, such as infections, damage to internal organs and
bleeding
A quicker recovery
Less need for pain relief after birth
Lower risk of breathing problems in the baby and need for admission to Special
Care Nursery
Fewer longer term problems, including decreased problems in future pregnancies.
Disadvantages of planned VBAC (compared to a repeat caesarean birth)
The main risk with attempting a VBAC is that the scar causes a weakness in the wall of the
uterus which can be at risk of tearing open during labour. This is called uterine rupture and
happens in about one woman in 250. When this happens it is important to deliver the baby
quickly.
Barwon Health maternity service is equipped to respond to this urgently, if it occurs.
Advantage of repeat caesarean birth (compared to a VBAC)
 Risk of uterine rupture is exceedingly low.
Disadvantages of repeat caesarean birth (compared to a VBAC)
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Higher rates of breathing problems in baby (overall risk of 3-4%). This is reduced by
performing the Caesarean Section at 39 weeks gestation.
Higher rates of complications in the mother. These include injury to internal organs
(bowel, bladder or ureters) and need for blood transfusions and hysterectomy.
Increased risk of placenta praevia in the next pregnancy.
Placenta praevia is when the placenta lies low in the uterus, covering the cervix and
means the baby should be delivered by caesarean section.
The risk after two caesarean sections is about 1 in 65 and rises to 1 in 10 after four
caesarean sections. Women with a placenta praevia have a high risk pregnancy and have
increased risks of complications at the time of their birth, blood transfusions, hysterectomy
(removal of the uterus) and admission to an intensive care unit.
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Induction of labour
Please refer to our Induction of labour patient information sheet. The most common reason
for induction of labour is being post term (defined as being at least ten to 12 days over
your agreed due date). Induction of labour in women who have had a previous caesarean
section increases the risk of complications such as uterine rupture and decreases the
chances of a successful vaginal birth. It is possible to opt for VBAC if you labour
spontaneously but if induction of labour is needed you may prefer an elective repeat
caesarean
Expectations for VBAC
In labour it is recommended that women having a VBAC have the baby’s heart rate
monitored continuously with a CTG (cardiotocograph). Women also have an IV line and
blood tests taken.
Otherwise, women having a VBAC are looked after in labour very similarly to women
having a normal labour and birth. Epidurals are available to women attempting VBAC.
Expectations for repeat caesarean section
An elective repeat caesarean section is performed at 39-40 weeks gestation on a planned
elective list. A spinal anaesthetic is used – this is very similar to an epidural. A small
number of women will go into labour before their planned caesarean section date. If this
happens, some women decide to continue with labour and VBAC. That decision is up to
you.
This document was developed by Maternity Services, Barwon Health, with acknowledgement to Southern Health
Prompt Doc No: BAH0005139 v3.0
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Due for review by: 29/08/2017