Can I have a vaginal birth after a caesarean?

Just because you had your first baby by caesarean, doesn’t necessarily mean all of your babies have to arrive the same way. Let’s explore whether you can have a VBAC and sort fact from fiction. 

It used to be thought that if you had a caesarean birth, any subsequent births would need to be delivered the same way. However, depending on your medical circumstances, vaginal birth after a caesarean section (also known as a VBAC) can be an option for welcoming your future babies into the world. For some women, a vaginal birth may be recommended by their doctor due to the risks involved with having multiple caesareans. 

Obstetrician Dr Sean Burnet from Sydney’s Mater Hospital says a range of factors are taken into account when considering whether you can have a vaginal birth after a caesarean. 

“Currently in Australia most health services are happy for people to try for a vaginal birth if they’ve had one caesarean section previously,” he says. “It’s important that it was what’s called a ‘lower segment’ caesarean section, and the baby isn’t looking too big. It has to have been more than 18 months between one baby and the next, less than that and it doubles the risk of rupture. The risk of rupture after one caesarean is one in 200 - so half a per cent - but the consequences are high.”

For most mums, their biggest concern is getting their baby into the world safely - regardless of how they arrive. However, many women want a vaginal birth, with studies showing that babies born this way have lower risk of allergies, likely because of the good bacteria released during vaginal birth. 

Other benefits of vaginal births, including VBAC, can include:

  • Shorter stay in hospital 
  • Lower risk of complications such as infection
  • Quicker recovery time
  • Feeling more physically able to take care of your baby soon after delivery
  • Reduced risk of your baby having breathing problems
  • Fewer complications with future pregnancies.

It’s estimated that 72 to 76 per cent of women who’ve previously had a caesarean will have a successful VBAC, however in some cases, your doctor may recommend you have an elective caesarean due to: 

  • Pregnancy complications, such as high blood pressure or the baby being in the breech position
  • Having had two or more caesareans already
  • A previous uterine (womb) rupture
  • Carrying more than one baby
  • Having a previous caesarean that was not performed through a lower segment cut. 
  • The reason for your previous caesarean still being a concern

If you opt for vaginal birth after a caesarean you’ll require close monitoring during delivery, and you’ll need to be in a hospital that’s equipped for a VBAC. Many regional hospitals, for example, aren’t able to offer caesareans in the event of an emergency.

It’s important to be aware of the risks of VBAC, Dr Burnet says.

“If you did rupture your uterus there’s a risk the placenta can separate immediately from the uterine wall and if you can’t deliver the baby within probably seven minutes, the baby could have serious consequences - even death or cerebral palsy,” Dr Burnet says. “There is also a risk of bleeding and heavy bleeding to the point of needing a hysterectomy.   

“My approach is, it’s very reasonable for women to try for a vaginal birth after having had one C-section, but what’s always important is that they have all the information.”

Talk to your doctor if you’re considering having a vaginal birth after a caesarean so you can make an informed choice based on the risks and benefits – for your safety and that of your little one. 

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