For women who have had a previous caesarean section, the choice for method of birth in their next pregnancy is either a trial of vaginal birth after caesarean section (VBAC) or a repeat caesarean section (RCS).
Caesarean section in a first pregnancy makes a subsequent caesarean section more likely, with 86% of women with a singleton pregnancy and a history of one or more previous caesarean section births, having a subsequent caesarean section (AIHW 2022). However, many women who choose to give birth vaginally after having had a previous caesarean section are successful (RANZCOG 2019).
Both RCS and VBAC are associated with benefits and risks. A successful VBAC can include a higher likelihood of an uncomplicated normal birth in future pregnancies, a shorter recovery and hospital stay, reduced abdominal pain after birth and lower risk of respiratory problems for the baby. Additional risks for the mother and baby when attempting a VBAC can include a chance of an emergency caesarean during labour, uterine scar rupture (5 to 7 out of 1000 attempts) which can result in serious problems for both the baby and mother and a low risk (2 in 1000 women) of the baby dying or having brain damage. The risks associated with a RCS includes those associated with any major surgery and the increased likelihood that all future births will be by caesarean section (RANZCOG 2016).
An individual woman’s preferences and risk profile will vary. Choice of birth option is best informed by discussion with maternity care clinicians with consideration of medical history, previous pregnancies, and availability of suitably qualified and trained staff and an appropriately equipped maternity unit (RANZCOG 2016).