Patient Information

Vaginal Birth After

Caesarean Section

ARTERIOGRAM
“Pregnancy is a time of choices and decisions.
In order to help you decide what is right for
you, you need information about any potential
advantages or disadvantages that there might
be in the options available.” (1)
This leaflet is for women who have had a caesarean to
inform you about birth choices this time. The information is
taken from the National Institute for Clinical Excellence
(NICE) Caesarean Section Guidelines (2). There is more
information on the NICE website (www.nice.org.uk).

Many women still believe that once a caesarean always a

caesarean. More than twenty years ago the World Health
Organisation said that there was no evidence that a repeat
caesarean was necessary after a previous lower segment
caesarean section (3).

At the Chelsea & Westminster Hospital we recommend that all

women who have had one previous uncomplicated caesarean
section should plan to have a vaginal birth after Caesarean
(VBAC). In some cases a trial of vaginal delivery is not
recommended and they will be referred to their consultant.

If you have had one uncomplicated caesarean section and have

no problems in your current pregnancy you will be seen in the
midwifery-led VBAC clinic where a senior midwife will
discuss birth choices and the benefits and risks of a VBAC. If
you had any complications in your previous caesarean,
concerns in this pregnancy or you request to see an obstetrician
your midwife will arrange an appointment with a consultant to
discuss your plan of care.
Your midwife will discuss the advantages and disadvantages of
a VBAC for you and your baby. You will need to take into
account what has happened in your previous pregnancies, how
things are in this pregnancy and your own feelings about the
birth.

At the Chelsea and Westminster Hospital you will have an

appointment with the specialist VBAC midwife if you request
an elective caesarean without a medical reason
The VBAC Midwives and Obstetricians are skilled in
supporting women to make an informed decision about their
labour and delivery empowering you to feel confident to have a
VBAC.

This leaflet provides further information about the risks and

benefits associated with caesareans to help you reach your
decision. Please do not hesitate to talk to your midwife if you
have any further questions.
The Benefits of VBAC

A normal vaginal birth is the safest way to have a baby for the
vast majority of women; the risk of death is greater with a
caesarean section (4) the risk of complications for VBAC is
less than the risks of having a repeat caesarean section (5).

The benefits to you and your baby include:-

• A lower chance of having an infection of the womb
following delivery.
• Babies born vaginally have a lower risk of respiratory
problems as the contractions of labour have been shown
to prepare their lungs to breathe (6).
• Women usually recover much more quickly and so can
care for their babies much sooner.
• Better chance of successfully breastfeeding.
• A shorter stay in hospital.

When a Caesarean is recommended.

There are times when the safest method of delivery for you and
your baby is a caesarean. This is when the benefits of surgery
outweigh the risks:
• Placenta Previa, when the placenta is positioned closed to
the neck of the womb.
• HIV positive women.
• If the position of the baby prevents a vaginal birth.
• If the baby or mother has a medical condition which
means a caesarean is safer option.
The Risks of VBAC

After a caesarean there is a risk the scar on your womb can

open up during your labour. The risk is 0.5% or 1: 200. The
opening up of the scar would require urgent delivery by
caesarean due to the risk of serious bleeding for the mother and
to prevent complications for the baby.

Your Care in Labour

Both mother and baby are closely monitored during labour.
Continuous Electronic fetal monitoring (EFM) of the baby’s
heartbeat is recommended by the NICE guidelines. The need
for EFM in women with previous caesarean is not based on any
evidence, it is a “Good Practice point” based on the view of the
Guideline Development Group. Women can be encouraged to
have an active birth whilst having continual monitoring;
however if they request active/waterbirth with intermittent
monitoring, women and their partners should understand that
there may be a delay in recognising fetal compromise and/or
scar rupture.

Place of Birth
Some women may consider a home birth after a previous
caesarean. The choice of place of birth is yours however a
hospital birth is strongly recommended as if problems develop
in labour this can result in a delay in the delivery of your baby.
You can discuss you birth plan with the Supervisor of
Midwives (remit of the Supervisors of Midwives is to ensure
choice and safety for childbearing women).
The Risks of Repeated Caesarean Sections

As a caesarean section involves major abdominal surgery, this

will therefore carry certain medical risks:
• Increased risk of uterine, abdominal wound, chest or
urinary infection.
• Increased risk of deep vein thrombosis (blood clots in
the legs that can travel to the lungs)
• Increased risk of hysterectomy.
• Increased risk of blood transfusion
• Scar tissue can cause long-term pain, bowel obstruction
and infertility.
• The risk to future pregnancies that having a scar on the
uterus can bring.
• Damage during the operation to the bladder and other
organs close to the uterus.
There are also potential problems for the baby:
• Increased risk of breathing problems.
• Occasionally the surgeon’s scalpel may cause injury to
the baby.

As well as the medical risks detailed above there are other

drawbacks:
• A longer recovery time with a greater need for pain
relief.
• Difficulty with breastfeeding due to pain.
• Longer stay in hospital
• Unable to obtain insurance to drive for six weeks
following a caesarean section.
Your Birth Plan.

Do think about all of your options carefully. Your VBAC

midwife and obstetricians are available to discuss any
questions that you may have. Whether your baby is born
vaginally or by caesarean section we want it to be a safe,
rewarding and satisfying experience for you and your family.

Where can I find more information?

National Childbirth Trust (NCT) 0870 770 3236

www.nctpregnancyandbabycare.com
www.informedchoice.org
www.birthchoiceuk.com
www.nice.org.uk
www.rcog.org.uk
www.vbac.co.uk
http://www.vbac.org.uk/
http://www.midirs.org
References

(1)Caesarean section and subsequent birth :Midirs Informed

Choice Leaflets Sept 2008.

(2)Caesarean section Clinical Guideline 13 National Institute

of Clinical Excellence April 2004

(3) World Health Organization. Appropriate technology for

birth. Lancet 1985;2(8452):436-7.

(4).Hall M. Caesarean section. In: Lewis G et al. Why mothers

die 1997-1999: the fifth report of
the Confidential Enquiries into Maternal Deaths in the United
Kingdom. London: RCOG Press,
2001:317-22.

(5) Enkin, M., et al (2000) A guide to effective care in

pregnancy and childbirth 3rd ed. Oxford University Press

(6).Levine, EM et al, (2001) “Mode of delivery and risk of

respiratory disease in newborns”. Obstetrics Gynaecology.
March. 97(3) pp 439-442

(7) Queen Elizabeth Hospital NHS Foundation Trust, ( 2005)

Vaginal Birth After Caesarean Section Patient Information
Leaflet.

April 2009