10 Tips For a Successful VBAC

1. Understanding VBAC in the UK Context

VBAC refers to giving birth vaginally after a previous caesarean birth. In the UK, VBAC is widely recognised as a safe and appropriate option for most individuals who have had one previous lower‑segment caesarean section.

According to the Royal College of Obstetricians and Gynaecologists (RCOG), VBAC is successful in 72–75% of cases. This means that approximately three out of four people who plan a VBAC will give birth vaginally. These figures are consistent across multiple UK maternity units and are supported by the National Maternity and Perinatal Audit (NMPA).

This success rate increases further under certain conditions:

• If you have had a previous vaginal birth, your VBAC success rate rises to 85–90%.

• If you have previously had a successful VBAC, the likelihood of success is even higher.

These statistics demonstrate that VBAC is not only possible but often highly successful.

2. Benefits of VBAC: Evidence‑Based Considerations

RCOG and NHS guidance highlight several benefits associated with a successful VBAC:

• Shorter recovery time compared with caesarean birth

• Lower risk of major abdominal surgery and associated complications

• Reduced likelihood of infection and haemorrhage

• Earlier mobilisation and bonding opportunities

• Lower risk of complications in future pregnancies, such as placenta accreta or placenta previa

From an academic perspective, these benefits align with broader public health goals of reducing surgical intervention where safe and appropriate.

3. Understanding the Risks: A Balanced Academic Perspective

All birth options carry risks, and VBAC is no exception. However, it is important to contextualise these risks accurately.

The most frequently discussed risk is uterine rupture, which occurs in approximately 0.2–0.5% of planned VBACs (RCOG). This equates to 2–5 cases per 1,000 births. While rare, it is a serious complication, which is why VBAC is recommended in settings where immediate access to emergency care is available.

The NHS emphasises that the overall risk of adverse outcomes remains low, and for many individuals, VBAC is a clinically appropriate and safe choice.

4. Key Factors That Increase VBAC Success

Evidence suggests that certain factors are associated with higher VBAC success rates:

• Previous vaginal birth, especially a previous VBAC

• VBAC friendly provider

• Spontaneous onset of labour

• Favourable cervical conditions at the onset of labour

• Absence of recurrent indications (e.g., the reason for your previous caesarean is unlikely to recur)

Understanding these factors can help you and your maternity team develop a personalised birth plan.

5. Planning Your VBAC: Practical and Evidence‑Informed Steps

5.1 Engage in Shared Decision‑Making

UK maternity care emphasises shared decision‑making, where your preferences and values are central. Discuss your birth history, current pregnancy, and concerns with your midwife or obstetrician.

5.2 Request a VBAC Consultation

Many NHS Trusts offer dedicated VBAC clinics or consultations. These appointments provide:

• A review of your previous caesarean

• An assessment of your individual VBAC preferences

• A personalised risk–benefit discussion

5.3 Prepare for Labour

Evidence suggests that spontaneous labour increases VBAC success. You may wish to explore:

• Antenatal education

• Relaxation techniques

• Physical preparation such as walking, yoga, or pelvic alignment exercises

5.4 Plan for Continuous Support

Continuous support during labour—whether from a partner, midwife, or doula—has been shown to improve birth outcomes, including VBAC success.

5.5 Understand When ERCS May Be Recommended

While VBAC is safe for many, an Elective Repeat Caesarean Section (ERCS) may be recommended if:

• You have had certain types of uterine incisions

• You have placenta previa

• There are concerns about fetal growth or wellbeing

You have the right to make decisions based upon the evidence and using the BRAIN tool can be useful in this situation.

6. Emotional and Psychological Dimensions of VBAC

Planning a VBAC is not solely a clinical decision; it is also an emotional one. You may feel hopeful, anxious, determined, or uncertain. These feelings are valid. Many individuals describe VBAC as a healing experience, particularly if their previous birth was challenging.

You deserve compassionate, evidence‑based support throughout this process. Your birth choices are deeply personal, and your autonomy is central to high‑quality maternity care.

References

• Royal College of Obstetricians and Gynaecologists (RCOG) – Birth After Previous Caesarean Birth (Green‑top Guideline No. 45)

• NHS – Your Pregnancy and Baby Guide: Vaginal Birth After Caesarean (VBAC)

• National Maternity and Perinatal Audit (NMPA) – Annual clinical reports on maternity outcomes

• NHS Trust VBAC Clinics – Localised guidance and patient information leaflets

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