Vaginal Birth After Caesarean Section (VBAC): Is It Possible for Me?

Author: Azibayam Aniayam Okrinya, MBBS

Medical Reviewer: Azuka Chinweokwu Ezeike, MBBS, FWACS, FMCOG, MSc (PH)

Highlights

• Vaginal birth after caesarean (VBAC) refers to having a vaginal delivery after a previous caesarean section (CS). 
• VBAC has a 60% to 80% success rate. 
• Several factors determine your eligibility for a VBAC, including your previous CS history and current medical and pregnancy history. 
• Uterine rupture is the most feared complication of a VBAC attempt.
• VBAC attempt should be done in a hospital with facilities for an emergency CS if needed. 

Introduction

“I had a caesarean section with my first baby. When I got pregnant with my second, I knew I wanted to try for a vaginal birth, but I always heard that once you’ve had a CS, your subsequent deliveries would have to be through CS.After speaking with my obstetrician about what I wanted, she told me about VBAC, explaining what it involved, including the benefits and possible risks. After which, she assessed if I was eligible for a VBAC, and thankfully I was.   

There was a point during labour when I thought I was going to have another CS, but I was able to have a vaginal birth.I think every mother who has had a CS should know that a vaginal birth may still be possible. But whether you have a VBAC or need another CS, what matters is having a safe birth for you and your baby.”

Jane

When a woman has a successful vaginal delivery after a previous caesarean delivery, it is called vaginal birth after caesarean (VBAC). To have a VBAC, you will undergo a trial of labour after caesarean (TOLAC). Success rate ranges from 60% to 80%. However, it carries potential risks which may result in serious, life-threatening problems for the mother and baby.  

In this article, you will learn what VBAC is, the factors that determine whether it is possible for you, the risks and benefits, and what questions you can ask your healthcare provider. 

What Does Vaginal Birth After Caesarean (VBAC) Mean?

Vaginal birth after caesarean section (VBAC) refers to a successful vaginal delivery after a previous caesarean section (CS) (a surgical procedure where a cut is made through your belly and uterus to deliver your baby). 

Women desiring VBAC delivery ideally undergo a trial of labour, also known as trial of labour after caesarean (TOLAC). 

What is Trial of Labour after Caesarean (TOLAC)? 

TOLAC is a planned attempt for a woman to deliver vaginally after a previous CS, regardless of the outcome [1]. 

If you meet the criteria for a VBAC, which will be discussed later in this article, your doctor may allow you to go into labour (TOLAC)  while closely monitoring you. 

If a TOLAC is successful, it results in a VBAC. If it is unsuccessful, it may result in a repeat CS. 

TOLAC aims to give women who want to have a vaginal delivery the chance to achieve it [1]. 

Can You Have a Vaginal Delivery After a Caesarean Section?

Like many other women with one previous CS, you can also achieve a vaginal delivery, but this depends on some individual factors. 

Published data have reported successful vaginal birth rates of 60% to 80% after a previous CS [2]. 

VBAC success rates can be as high as 90% in women who have had one previous CS and a vaginal birth either before or after the CS. However, the success rate may be lower than 60% in women whose previous CS was performed for a recurring reason, as well as in those with obesity or a suspected large baby [2].

Planned VBAC is appropriate for and may be offered to the majority of women pregnant with a single baby, in head-down position between 37 - 41 weeks, who have had a single previous lower segment caesarean delivery, with or without a history of previous vaginal birth [2].Below are the factors that can determine whether VBAC is safe for you. 

What Factors Determine Whether VBAC Is Safe for You?

Your healthcare provider will assess whether VBAC is safe and suitable for you by using information from your previous CS and current medical and pregnancy history. A decision is made considering several factors,

Factors That May Increase the Chances of a Successful VBAC

• Previous vaginal birth and VBAC

Women who have had a vaginal birth before, especially a previous VBAC, are more likely to have a successful VBAC. Success rate increases with a history of previous vaginal births [2].

• A non-recurrent reason for previous CS

Women whose previous CS was for conditions that don't recur, like breech presentation, have higher chances of VBAC success than for reasons that can recur, such as an arrest of labour [2].

• Labour characteristics 

Natural onset of labour, normal labour progression, and a baby in the normal position at 37- 41 weeks are associated with a higher chance of VBAC success [2]. 

Factors that may decrease the chances of a successful VBAC

• Number of previous CS

Women with one previous CS, in the absence of any contrary indication to vaginal birth, have a higher chance of VBAC success. VBAC is not recommended after two previous CS because of associated risks and potential complications. However, two previous CS may be considered in carefully selected women [2,3].

• Type of uterine cut (incision) used during the previous CS

VBAC is relatively safe and associated with low risks of uterine rupture in women with a previous low transverse uterine incision. However, it is not recommended in women with a previous classical (vertical) incision. A planned repeat CS is recommended in this case due to the higher risk of uterine rupture [2,3].

• Suspected fetal macrosomia 

Women attempting VBAC with suspected fetal macrosomia (babies with an estimated weight of 4kg or more) have lower chances of a successful VBAC compared to women with non-macrosomic babies. However, this isn’t an absolute contraindication for VBAC [2,3]. 

• Maternal BMI of 30 kg / m2 or more

A review showed that obese women with a body mass index (BMI) of 30 kg / m2  or more have a lower chance of a successful VBAC. However, this factor alone shouldn’t determine VBAC [2,3]. 

• Older maternal age

Younger age is associated with a higher likelihood of a successful VBAC compared to women with advanced age. A review showed that the chances of a successful VBAC are lower in women aged 40 and above, as they are more likely to have complications.  

• Pregnancy beyond 41 weeks

VBAC attempts at or after 41 weeks of pregnancy may be associated with an increased risk of uterine rupture, which reduces chances of success [3].

What Are the Benefits of a Successful VBAC? 

For women who have a successful VBAC, there are significant benefits. They include:

• Provides an option for women who want to experience vaginal birth [4]. 

• Avoidance of major abdominal surgery and the risks associated with a repeat CS [4].

• Faster recovery and shorter hospital stay

• Less blood loss

• Reduced risk of infection 

• Reduced risk of hysterectomy, bowel or bladder injury, placenta problems and other complications associated with multiple C-sections

What Are the Risks of VBAC?

VBAC attempts carry risks which could lead to serious complications for the mother and child. These include risks of :

• Uterine rupture: This is the most serious rare complication associated with VBAC attempts that doctors try to avoid, as it leads to serious problems for the mother and the baby. 

CS leaves a scar on your uterus. This scar may separate and/or tear (rupture). According to the Royal College of Obstetricians and Gynaecologists (RCOG), this can occur in 1 in 200 women. This risk increases by 2 to 3 times if your labour is induced. [4,5] 

• Blood loss & transfusions: following uterine rupture, patients may experience serious bleeding which could require transfusions [5]. 

• Emergency caesarean delivery and its complications: if a VBAC attempt fails, there may be an urgent need for CS to save the mother and baby [5]. 

• Hysterectomy: Bleeding from uterine rupture may sometimes require the uterus to be removed (hysterectomy) to control the bleeding and save the woman's life.

• Risks to the baby: When uterine rupture occurs, the transfer of blood and oxygen needed for the baby’s survival is interrupted, and this can lead to problems like the need for neonatal intensive care unit (NICU) admission, brain injury and stillbirth [5].

• Risk of a tear involving the muscles of the vagina, anus or rectum [5].

When Might a Repeat Caesarean Section Be Recommended?

There are a few occasions when a VBAC is not advisable, and a repeat CS is a safer option [5]. These include:

• Two or more previous Caesarean deliveries

• Previous uterine rupture

• Previous classical uterine incision 

• Other pregnancy complications that may require a Caesarean delivery
• A recurrent reason

• When the interval between the previous caesarean deliveries and the current pregnancy is short

You may need to have an emergency caesarean section during labour. The most common reason for an emergency caesarean section is if your labour slows or if there is a concern for the safety of your baby [5]. 

What Happens During Labour After a Previous Caesarean?

Labour after a previous caesarean section should be managed in a hospital that has the facilities to perform an emergency CS if needed.

Natural labour is preferred as it carries a higher risk of successful vaginal delivery and a lower risk of uterine rupture. Induction of labour is, however, an option when indicated [6]. 

Once you go into labour and start having regular contractions, your baby's heartbeat will be monitored continuously, as changes in the heartbeat pattern can be an early sign of problems with the previous scar. 

Pain relief (epidural anaesthesia) can also be given during labour [6]. 

If labour isn't progressing as expected or your health care provider suspects a problem, you may immediately be booked for an emergency repeat CS [6].

If labour does not start by 41 completed weeks, your healthcare provider will discuss your birth options again with you.  

Questions to Ask Your Healthcare Provider About VBAC

VBAC has its risks and benefits. Talk to your healthcare provider so you understand the risks and benefits and what they mean for you.Some questions you can ask your obstetrician include:

• Am I  a good candidate for VBAC?

• What are my chances of having a successful VBAC?

• What factors in my medical or pregnancy history can affect your chances of a successful VBAC?

• Are there any problems in my current pregnancy that could make VBAC unsafe for you

• What happens if I need an emergency C-section during labour

• Does the hospital have the facilities to perform an emergency C-section if needed

• At what point would you recommend changing from a planned VBAC to an emergency C-section

• What happens if I go into labour before your planned delivery date

Conclusion

Vaginal birth after caesarean (VBAC) may be possible for women who want to experience it and may be a safe option for appropriately selected women. However, the right choice depends on the individual, her previous CS history, current medical and pregnancy history and the availability of resources where she plans to give birth. If you want to have a VBAC, see your healthcare provider, who can guide you through the process.

References 

1. ACOG. Vaginal birth after cesarean delivery [Internet]. www.acog.org. 2019 [cited 2026 Sept 27]. Available from: https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2019/02/vaginal-birth-after-cesarean-delivery
2. Barnea ER, Ramasauskaite D, Ubom AE, Di Simone N, Mueller M, Borovac‐Pinheiro A, et al. FIGO good practice recommendations for vaginal birth after cesarean section. International Journal of Gynecology & Obstetrics [Internet]. 2025 July 29 [cited 2026 Sept 26];171(1):17–31. Available from: https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.70406
3. ACOG. Practice Bulletin No. 184: Vaginal Birth After Cesarean Delivery. Obstetrics & Gynecology [Internet]. 2017 Nov [cited 2026 Sept 26];130(5):e217–33. Available from: https://journals.lww.com/greenjournal/pages/articleviewer.aspx?year=2017&issue=11000&article=00048&type=Fulltext
4. Miazga E, Reed C, Olsthoorn A, Fan I, Zhao E, Shapiro J, et al. Investigating the implementation of a trial of labour after caesarean (TOLAC) delivery bundle with respect to decreasing caesarean delivery rates: A multisite quality improvement initiative. BMJ Open [Internet]. 2025 Jan [cited 2026 Sept 27];15(1):e088734. Available from: https://bmjopen.bmj.com/content/bmjopen/15/1/e088734/DC2/embed/inline-supplementary-material-2.pdf?download=true
5. RCOG. Birth after previous caesarean | RCOG [Internet]. RCOG. Birth after previous caesarean | RCOG; 2016 [cited 2026 Sept 27]. Available from: https://www.rcog.org.uk/for-the-public/browse-our-patient-information/birth-after-previous-caesarean/
6. Habak PJ, Kole M. Pregnancy, vaginal birth after cesarean delivery (VBAC) [Internet]. PubMed. StatPearls Publishing; 2023 [cited 2026 Sept 27]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507844/

Disclaimer:
The information provided on this website is for general educational and informational purposes only. It is not intended to replace professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Published October 22, 2026