Vaginal birth after caesarean (VBAC)
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Planned VBAC is appropriate for, and may be offered to the majority of women with a singleton pregnancy with cephalic presentation at 37+ weeks' gestation, who have had a single previous lower segment caesarean delivery, with or without a history of previous vaginal birth. It has a success rate of 72 - 75 per cent, but where the woman has experienced previous vaginal birth, particularly VBAC, this increases to 85 - 90 per cent.
Successful VBAC has the fewest complications, and the greatest risk of adverse outcome is associated with a trial of VBAC resulting in emergency caesarean delivery.
VBAC is contraindicated in women with previous uterine rupture or classical caesarean scar and in women who have other absolute contraindications to vaginal birth that apply irrespective of the presence or absence of a scar.
An individual assessment of suitability for VBAC should be made in women with factors that increase the risk of uterine rupture. The incidence of uterine rupture in VBAC is 1 in 200 (0.5 per cent).
Planned VBAC should take place in a suitably staffed and equipped delivery suite with resources available for immediate caesarean delivery and advanced neonatal resuscitation.
Royal College of Obstetricians & Gynaecologists. (2015) Birth after previous caesarean birth. Green-top Guideline No 45. https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_45.pdf
White HK, le May A, Cluett ER. (2016) Evaluating a midwife-led model of antenatal care for women with a previous caesarean section: a retrospective, comparative cohort study. Birth (e-Pub 18 Mar 2016) DOI: 10.1111/birt.12229. http://onlinelibrary.wiley.com/doi/10.1111/birt.12229/abstract;jsessionid=9ED2B576C805FF5A1F0C744AFAC44A2C.f01t03