VBAC – Facts and Statistical Information

It used to be said that ‘once a caesarean, always a caesarean’, this is no longer the case and in the UK VBACs are becoming more encouraged and more common. I am slightly biased on this topic as I have had two caesareans, followed by two VBACs; however, I will try to write from a non-biased view to allow you to make an informed decision. I have researched from RCOG (The Royal College of Obstetricians and Gynaecologists) to ensure that the information is accurate and current.

Are you a good candidate for a VBAC?

The majority of women in the UK are offered to attempt a VBAC, as long as you fit the criteria then you have a fair chance of having a VBAC:

  • A low-transverse caesarean scar
  • No history of previous scar rupture
  • Baby is in a head down (cephalic) position

This risks of VBAC increase when:

  • The woman has a classical caesarean scar
  • The woman has had placenta praevia
  • Woman who’ve experienced previous uterine rupture
  • Women with a previous classical scar (high vertical incision)
  • Women with a T or J incision
  • Less than 12 months since last delivery
  • Post-date pregnancy
  • Maternal age of 40 years or more

Can women with two or more caesareans attempt a VBAC?

Most obstetricians in the UK will offer women with two previous caesareans the chance to attempt a VBAC; an analysis of the NICHD study showed that there was no significant difference in the rates of uterine rupture in VBAC with two or more previous caesarean births (92/10 000) compared with a single previous caesarean birth (68/10 000), and successful VBAC rates remain the same (62-75%). RCOG states that women with two previous caesareans should be told the following information:

  • VBAC success rate (71.1%),
  • Uterine rupture rate (1.36%)
  • Risk of hysterectomy (56/10 000)
  • Risk of blood transfusion (1.99%)
  Planned VBAC Planned Caesarean
Maternal Outcomes 72–75% chance of successful VBAC Able to plan the delivery date
  Shorter hospital stay and quicker recovery Virtually avoids the risk of uterine rupture (less than 0.02%)
  Approximately 0.5% risk of uterine scar rupture Longer recovery
  Increases likelihood of future vaginal birth Reduces the risk of pelvic organ prolapse and urinary incontinence
  Risk of anal sphincter injury Can be sterilised at the same time if that’s what the woman wants (although this needs to be agreed 2 weeks before the procedure)
  Risk of maternal death is 4/100,000 likely to require caesarean delivery in future births
    increased risk of

placenta praevia/accreta and adhesions

with successive caesarean deliveries

    Risk of maternal death is 13/100,000
Infant outcomes Risk of transient respiratory morbidity of 2–3%. Risk of transient respiratory morbidity of 4–5%
  10 per 10 000 (0.1%) risk of stillbirth <1 per 10 000 (<0.01%) risk of delivery related perinatal death or HIE
  • 8 per 10 000 (0.08%) risk of hypoxic ischaemic encephalopathy (HIE) 4 per 10 000 (0.04%) risk of delivery-related

perinatal death

This post has given the statistical information for VBACs; on my next post I will discuss your options during your VBAC labour.

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