Birth After Previous Caesarean Birth

RCOG Green-top Guideline No. 45 Birth After Previous Caesarean Birth. Last reviewed Oct 2015.

Article Last Updated:05/04/2026

Definitions and Choices

Delivery options for a woman who had a previous Caesarean delivery are:

Delivery option	Description
Vaginal birth after previous caesarean delivery (VBAC)	Timing: 37 weeks or beyond Setting: delivery suite that has Continuous intrapartum care and monitoring Resources for immediate Caesarean delivery Advanced neonatal resuscitation capabilities Key requirements: One-to-one supportive care Continuous electronic fetal monitoring (to detect early signs of uterine rupture) Induction and/or labour augmentation should be proceeded with caution if considered necessary due to increased risk of uterine rupture and caesarean delivery.
Elective repeat caesarean section (ERCS)	Timing: after 39 weeks of gestation Routine practices prior to Caesarean delivery: Pre-incision antibiotics (BNF recommends IV cefuroxime) (avoid co-amoxiclav) Thromboprophylaxis If ERCS must be performed <39 weeks → consider maternal corticosteroids to reduce risk of neonatal respiratory distress syndrome

Delivery option

Description

Vaginal birth after previous caesarean delivery (VBAC)

Timing: 37 weeks or beyond

Setting: delivery suite that has

Continuous intrapartum care and monitoring
Resources for immediate Caesarean delivery
Advanced neonatal resuscitation capabilities

Key requirements:

One-to-one supportive care
Continuous electronic fetal monitoring (to detect early signs of uterine rupture)

Induction and/or labour augmentation should be proceeded with caution if considered necessary due to increased risk of uterine rupture and caesarean delivery.

Elective repeat caesarean section (ERCS)

Timing: after 39 weeks of gestation

Routine practices prior to Caesarean delivery:

Pre-incision antibiotics (BNF recommends IV cefuroxime) (avoid co-amoxiclav)
Thromboprophylaxis

If ERCS must be performed <39 weeks → consider maternal corticosteroids to reduce risk of neonatal respiratory distress syndrome

Decision Making – VBAC vs ERCS

VBAC Suitability and Contraindications

Planned VBAC is suitable for:

Singleton pregnancy with the baby in cephalic presentation, and
37 weeks or beyond, and
Only had a single previous lower-segment caesarean delivery

Regardless of any previous vaginal birth

Women with two or more prior lower-segment caesarean deliveries may still be offered a planned VBAC, provided they undergo specialised counselling by a senior obstetrician regarding the individual risks and likelihood of success.

Key factors that make VBAC NOT appropriate:

Absolute contraindications	Previous classical caesarean scar (vertical midline incision) Previous uterine rupture Absolute contraindications to vaginal birth (e.g. placenta praevia) (i.e. any absolute indications for Caesarean birth – see the Vaginal Delivery and Caesarean Section article for more information)
Caution + decided by senior obstetricians	Complicated uterine scars Twin pregnancy Post-dates (>41 weeks) Suspected fetal macrosomia Maternal age ≥40 y/o

Risk and Benefit (VBAC vs ERCS)

	VBAC	ERCS
Maternal benefits	72–75% success rate (the single best predictor of a successful VBAC is a previous vaginal birth, particularly a previous VBAC) If VBAG is successful: Fewest complications Shorter hospital stay and recovery Avoids surgical risk Higher likelihood of future vaignal births Lower absolute risk of maternal death	Known delivery date Virtually avoids risk of uterine rupture (<0.02%) Lower risk of pelvic floor injury and urinary incontinence
Maternal risks	May result in emergency caesarean delivery Uterine rupture (0.5% risk) Anal sphincter injury (5% risk, related to birthweight) Increased rate of instrumental delivery (assisted vaginal delivery) VBAC with induction and/or augmented labour has 2-3 fold increased risk of uterine rupture and 1.5 fold increased risk of caesarean delivery	Longer recovery Likely to require caesarean delivery for future pregnancies Small increased risk of maternal mortality Small increased risk of placenta praevia, placenta accreta, pelvic adhesions
Fetal risks	Slightly higher increased risk of HIE compared to ERCS	Small increased risk of transient respiratory morbidity

VBAC

ERCS

Maternal benefits

72–75% success rate (the single best predictor of a successful VBAC is a previous vaginal birth, particularly a previous VBAC)

If VBAG is successful:

Fewest complications
Shorter hospital stay and recovery
Avoids surgical risk
Higher likelihood of future vaignal births
Lower absolute risk of maternal death

Known delivery date
Virtually avoids risk of uterine rupture (<0.02%)
Lower risk of pelvic floor injury and urinary incontinence

Maternal risks

May result in emergency caesarean delivery
Uterine rupture (0.5% risk)
Anal sphincter injury (5% risk, related to birthweight)
Increased rate of instrumental delivery (assisted vaginal delivery)

VBAC with induction and/or augmented labour has 2-3 fold increased risk of uterine rupture and 1.5 fold increased risk of caesarean delivery

Longer recovery
Likely to require caesarean delivery for future pregnancies
Small increased risk of maternal mortality
Small increased risk of placenta praevia, placenta accreta, pelvic adhesions

Fetal risks

Slightly higher increased risk of HIE compared to ERCS

Small increased risk of transient respiratory morbidity

Reference

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