Why Vaginal Birth After Caesarean (VBAC)?

If you’ve had a C-section before, you’re likely feeling a mix of emotions—fear, hope, uncertainty. Maybe you’re wondering whether a VBAC (Vaginal Birth After Cesarean) is possible for you, or if it’s even safe. It’s a big decision, but the good news is that a VBAC could be your chance to have the birth experience you’ve always hoped for.

VBAC is a real possibility for many women—and not just a chance at a different birth, but a chance to reclaim your body and experience birth in a new way. In this guide, I’ll walk you through the steps to plan and achieve your VBAC dreams, and show you why it’s possible for you. If you’ve ever considered a VBAC, read on to see how you can make it happen.

What is a VBAC and Why It’s Possible for You

VBAC is the term used when a woman has a vaginal birth after a previous cesarean section. While VBACs are often perceived as high-risk, they can be a very safe option for many women.

Research suggests that the success rate for VBAC ranges from 60-80%, depending on various factors like the type of previous C-section, your health, and your baby's health. Studies also show that the risk of complications is lower for VBACs compared to repeat C-sections.

It's important to note that VBAC is not always possible for every woman, but many women are surprised to find that they are candidates for it. Factors like a low transverse C-section scar, being in good health, and a full-term pregnancy with a baby in a head-down position can all increase the chances of a successful VBAC.

Common Reasons for Previous Caesarean Section

Understanding why your previous caesarean was recommended can be critical to planning your VBAC, if you're not sure you can request your medical records from your birthing hospital (Access your WA Health medical records). The most common reasons include:

• Induction causing fetal distress: Often, labour is induced with synthetic hormones like Syntocinon, leading to stronger more frequent contractions that can cause fetal distress.
• Failure to progress: This is often a result of medical interventions, interruptions to the birth space or lack of support and time during labour.
• Breech presentation: A breech baby is often delivered via C-section. However, there are options like the KEMH Breech Clinic for women wanting a vaginal breech birth.
• Placenta previa or low-lying placenta: A caesarean may be necessary in these situations, but this condition often resolves as the pregnancy progresses so its essential you have this reassessed in late pregnancy.

Choosing the Right Care Provider

Planning a VBAC (Vaginal Birth After Cesarean) starts long before you go into labour. It involves assembling the right team, making informed choices, and preparing both your body and mind for birth. One of the most significant factors in achieving a successful VBAC is your choice of care provider. Research consistently shows that VBAC outcomes improve when you're supported by providers who are experienced, respect physiological birth, and follow evidence-based guidelines (VBACTool, 2021). However, not all OBs or midwives are open to VBAC, and there’s a big difference between being "VBAC tolerant" and truly "VBAC supportive." It’s essential to find a provider who respects your autonomy and fully supports your VBAC choice.

Public Hospital Care

Public hospitals in Australia generally have higher VBAC rates than private hospitals. In 2022, 14.5% of women in public hospitals had a vaginal birth after caesarean, compared with just 5.3% in private hospitals (AIHW, 2023). Public hospitals tend to follow more standardised clinical guidelines, and midwifery group practices (MGP) or continuity-of-care models are sometimes available — both of which are associated with higher VBAC success and greater satisfaction.

That said, not all public hospitals are equally VBAC-friendly, and often this comes down to the current midwifery and obstetric teams. Some enforce restrictive standard policies, such as continuous monitoring, mandatory cannulation, or early admission in labour, which can increase the likelihood of intervention.

Private Hospital Care

Private hospitals operate under an obstetric-led model, where acceptance of VBAC may be limited. In 2022, across Australia, only 5.3% of women had a VBAC in private hospitals (AIHW, 2023). Obstetricians in the private system may have a lower threshold for recommending repeat caesarean due to perceived medical risks or scheduling convenience. You may like to read my other blog post: Why You Don't Need an Obstetrician - Mother Mother Doula & Photographer

However, some women value the continuity of seeing a known obstetrician throughout pregnancy. If you're considering private care and want to pursue a VBAC, it’s worth asking your provider about their personal VBAC rates and approach to supporting spontaneous labour.

Home Birth After Caesarean (HBAC)

For some women, planning a homebirth after a previous caesarean (HBAC) is an empowering and viable option. Although not supported as a Medicare-funded option (VBAC is an exclusion criteria for the Community Midwifery Homebirth Program), research shows that planned HBAC can be both safe and successful when attended by experienced Privately Practicing Midwives.

What Does the Research Say? A large UK study found that 87% of women planning HBAC had a successful vaginal birth. When it comes to safety, the numbers are comparable: serious maternal complications occurred in 2.3% of planned HBACs versus 2.8% in hospital VBACs, with neonatal admission rates also being similar (5.1% for HBAC vs 5.6% for hospital VBAC). Other research also supports these positive outcomes, with VBAC success rates ranging from 87–91% in US-based homebirth groups and uterine rupture rates similar to those in hospital VBAC settings (PMC, 2016; Wiley, 2022).

Why Do Women Choose HBAC? Many women find that HBAC offers a sense of autonomy and emotional healing, particularly after previous birth trauma. Studies highlight that women often feel a stronger sense of control, trust in their bodies, and greater satisfaction with their care when they choose HBAC (BMC Pregnancy & Childbirth, 2017).

The Risks of VBAC vs Repeat C-Section: What You Need to Know

It’s important to understand both the potential risks of a VBAC and the risks of a repeat C-section. While the risks of VBAC are often highlighted, the risks of a repeat C-section should also be considered in your decision-making process.

VBAC Risks: While rare, one of the main risks associated with VBAC is uterine rupture. This occurs when the scar from your previous C-section tears during labour. It’s a serious complication, but the risk is low. The overall risk of uterine rupture in women attempting a VBAC is about 0.5-1%, depending on several factors. Other risks commonly associated with VBAC include infection, blood loss, and the need for an emergency C-section if complications arise during labour.

Repeat C-Section Risks: On the other hand, a repeat C-section comes with its own set of risks, including longer recovery times, increased chances of infection, potential complications in future pregnancies (such as placenta previa or placenta accreta), and higher risks for baby such as NICU stays, prematurity and difficulties establishing breastfeeding.

Both options come with risks, but it’s about weighing those risks against your personal preferences, medical history, and birth goals. Here's two comparison chats to help:

Uterine Rupture Risk: Spontaneous vs. Induced or Augmented Labor

The onset of labour significantly influences the risk of uterine rupture in women attempting a VBAC. According to the RCOG Green-top Guideline No. 45, the estimated risks for Uterine Rupture are as follows:​

• Spontaneous labour: 0.15–0.4%
• Induced labour: 0.54–1.4%
• Augmented labour: 0.9–1.91%​

These figures show that induction or augmentation of labour increases the risk of uterine rupture compared to spontaneous labour. It's important to note that the method of induction also plays a role. Mechanical methods, such as amniotomy or Foley catheter, are associated with a lower risk of scar rupture compared to pharmacological methods like prostaglandins and syntocinon (synthetic oxytocinon).

How to Increase Your Chances of a Successful VBAC

There are several steps you can take to improve your chances of a successful VBAC. The more prepared you are physically, mentally, and emotionally, the better. Additionally, understanding hospital policies and knowing how to navigate them can make a big difference in achieving the birth you desire.

1. Physical Preparation: Regular exercise and bodywork is key for strengthening your body and optimising balance and alignment. Specific exercises and stretches that open the pelvis and prepare your pelvic floor for labour can be especially helpful. Prenatal yoga, pelvic floor exercises, and gentle stretching all contribute to a positive outcome.

3. Mental Preparation & Education: VBAC is as much a mental journey as it is a physical one. It’s important to prepare yourself mentally for your birth. Understanding the process of birth and knowing that your body is capable can help reduce fear. Consider hiring a doula to support you through this mental preparation and help with coping techniques.

4. Communicate Openly with Your Birth Team: Having open and honest conversations with your medical team about your VBAC goals is crucial. Make sure they are supportive and understand your wishes for your birth. Your team should want to listen to your preferences and do everything they can support you in achieving your VBAC.

5. Understanding Hospital Policies & Navigating Your Birth Plan: Hospital policies can play a significant role in your ability to achieve a VBAC. Rules around post-dates, large babies, induction, and continuous monitoring may interfere with the natural progression of labour and lead to unnecessary interventions. Being aware of these policies allows you to make informed decisions and avoid interventions that don’t align with your birth plan. Building a strong, supportive care team is key. A knowledgeable team can help you navigate hospital protocols, advocate for your wishes, and provide the emotional and physical support you need throughout labour. It's essential to have people who know and respect your preferences in your corner.

6. Approaches to Limit Intervention During Labour and Birth: Many women who have VBACs are concerned about interventions like induction or continuous monitoring that could disrupt the natural flow of their labour. The American College of Obstetricians and Gynaecologists (ACOG) outlines several approaches to limit unnecessary interventions during labour and birth. This includes using movement during labour, being mindful of the timing of interventions, and making informed choices about pain management. These steps can significantly improve your chances of achieving a successful VBAC.

Overcoming Challenges and Embracing Your Birth Journey

While a VBAC can be a beautiful experience, it’s important to acknowledge that things don’t always go according to plan. There may be unexpected challenges or moments of uncertainty. But that doesn’t mean you’ve failed or that you can’t have a positive birth experience.

The most important thing to remember is that flexibility is key. VBACs, just like all births, are unpredictable. Even if things don’t go exactly as planned, you can still have an empowering, positive experience. Stay focused on your goals, trust your body, and know that you are supported by a team that believes in you.

By educating yourself, choosing a supportive care team, and being prepared, you can significantly increase your chances of a successful VBAC. It's important to remember that every pregnancy is different, and the choice between VBAC and repeat C-section should always be based on your personal circumstances, preferences, and medical needs.

Additional Resources

• Royal College of Obstetricians and Gynaecologists (RCOG): Vaginal Birth After Cesarean (VBAC) Guidelines
• American College of Obstetricians and Gynecologists (ACOG): Vaginal Birth After Cesarean (VBAC) Practice Bulletin
• American College of Obstetricians and Gynecologists (ACOG): Approaches to Limit Intervention During Labor and Birth
• American College of Obstetricians and Gynecologists (ACOG): Why I Had a Doula Help with My Delivery
• VBAC.com: Vaginal Birth After Cesarean
• The VBAC Link: VBAC Resources and Support
• International Cesarean Awareness Network (ICAN): ICAN Resources
• Evidence Based Birth: The Evidence on VBAC
• Hazel Keedle: Birth After Cesarean Book (A must read)
• Ashley Winning: Podcast
• The Midwives Cauldron: VBAC Interview with Dr. Hazel Keedle
• The Great Birth Rebellion (Podcast): Episode on VBAC
• Mother Mother Doula: Why You Don’t Need an Obstetrician
• Mother Mother Doula: Birthing Options: Perth to Mandurah, Western Australia