Caesarean Section Vs VBAC: What's the Difference

Choosing how you want to birth your baby is one of the most personal decisions you’ll make. If you’ve previously had a caesarean section, you might be wondering what your options are for your pregnancy. Can you attempt a vaginal birth after having a previous caesarean section?

You’ll be relieved to know that it is possible for many women who have previously had a caesarean section to have a vaginal birth. This is known as vaginal birth after caesarean or VBAC for short. There are advantages and disadvantages to both repeat caesarean section and VBAC. The best option for you will depend on your personal health history and your own preferences.

Here at myGynaePlus, we know how important it is to have all the evidence-based information before deciding. That’s why our obstetrics team will walk you through your options during your pregnancy, birth, and postnatal care. First things first, let’s look at what the two options entail.

What Is a Caesarean Section?

A caesarean section, also known as a C-section, is when your baby is born through cuts in your abdomen and womb. NHS statistics show that more than one in five babies in the UK are now delivered by caesarean section - they're very common.

Caesareans can be scheduled in advance (elective) or performed as an emergency if continuing with vaginal birth would be unsafe. Most uncomplicated caesareans will take around 45 minutes from beginning to end. Emergency caesareans will usually take less time. 

When Is a Caesarean Section Necessary?

Caesarean sections are recommended when vaginal birth poses risks to mother or baby. Common reasons include:

• Baby in breech position (feet or bottom first)

• Placenta previa (placenta covering the cervix)

• Multiple babies (twins, triplets)

• Previous uterine surgery

• Certain maternal infections like genital herpes or untreated HIV

• Baby not getting enough oxygen during labour

• Labour failing to progress

• Concerns about baby's heart rate

Your healthcare provider will discuss whether a caesarean is medically necessary or if vaginal birth remains safe.

The Caesarean Procedure: What to Expect

Caesarean section (also known as a c-section) is when your baby is delivered through cuts in your abdomen and womb. NHS figures show that in the UK more than one in five babies are delivered by caesarean - they're very common.

You can have either an elective caesarean section (planned) or an emergency one if a vaginal birth is considered unsafe. A caesarean usually takes about 45 minutes from beginning to end. Emergency procedures may be quicker. 

What Is VBAC?

VBAC is short for vaginal birth after caesarean. It refers to having a vaginal birth following the previous birth by caesarean section. Research indicates that VBAC has a success rate of 60% to 80%, so it can be an option for many.

VBAC is sometimes referred to as "trial of labour after caesarean", also known as TOLAC by medical professionals. If the trial is successful you have a VBAC. If problems occur you might need to have an emergency caesarean.

Who Can Have a VBAC?

VBAC isn't suitable for everyone, but most women with one previous caesarean are good candidates. Your chances improve if:

• You had a low transverse (horizontal) incision in your uterus during your previous caesarean

• Your previous caesarean was for a non-recurring reason (like breech position, not labour difficulties)

• You've had a previous vaginal delivery

• You're under 35 years old

• Your current pregnancy is straightforward

• You go into labour spontaneously rather than being induced

After one caesarean section, about three out of four women with a straightforward pregnancy who go into labour naturally give birth vaginally. If you've had a vaginal birth before, your success rate jumps to 85-90%.

When Is VBAC Not Recommended?

VBAC carries higher risks in certain situations. Your healthcare provider will likely recommend a repeat caesarean if:

• Your previous caesarean involved a vertical (classical) or T-shaped uterine incision

• You've had a previous uterine rupture

• You've had other uterine surgery where the cavity was entered

• You're carrying multiples (twins or more)

• You have placenta previa or other complications in your current pregnancy

• The hospital doesn't have immediate access to emergency caesarean facilities

At myGynaePlus, our experienced obstetrics team can review your medical records and help determine whether VBAC is a safe option for you.

Caesarean Section Vs VBAC: Key Differences

Understanding the differences between these birth methods helps you weigh your options. Here's what sets them apart.

Recovery Time and Hospital Stay

Caesarean and VBAC have different recoveries. If you have a VBAC, you'll recover in two to four weeks and get to leave the hospital earlier - usually within 24 to 48 hours. Recovery from caesarean takes six to eight weeks, and you'll spend three to four days in hospital. 

As caesarean section is major abdominal surgery there are restrictions on driving, exercise and lifting for the first six weeks after birth. VBAC gives you a quicker return to normal activities.

Risks for Mother

Both options come with risks. Some risks associated with caesarean are wound infection, where the incision becomes red, swollen and painful, and infection of the lining of the womb. Symptoms of this may include fever and heavy bleeding. Blood loss and deep vein thrombosis are also risks, although they're less common.

The main risk with VBAC is rupture of the womb. This happens when the scar from the previous caesarean tears open. For women who have had one previous low transverse caesarean section, the risk of rupture is 0.3% to 0.7%. This is around 1 in 200 women. Symptoms that might indicate rupture are monitored closely with continual foetal heart monitoring during labour.

Around one in four women attempting a VBAC will end up having an unplanned caesarean in labour. Emergency caesareans are usually slightly more risky than planned ones.

Implications for Future Pregnancies

Your choice affects future pregnancies. Most women who have had a caesarean section have no problems in future pregnancies, but there is an increased risk of problems such as the scar opening up and difficulties delivering the placenta.

Each caesarean increases these risks. If you're planning several more children, this matters. Successful VBAC means fewer complications in subsequent pregnancies.

Risks for Baby

Babies born by planned caesarean face slightly higher breathing problems. Research shows 4 to 5 in 100 babies born by planned caesarean at or after 39 weeks have breathing issues, compared to 2 to 3 in 100 following VBAC. These problems usually resolve quickly.

During VBAC, if uterine rupture occurs, there's a small risk of oxygen deprivation. However, continuous monitoring allows healthcare teams to respond immediately to any concerns.

Emotional and Personal Considerations

Many women have strong feelings about their birth experience. Some prefer the predictability of a planned caesarean, whilst others feel strongly about experiencing vaginal birth. Previous birth trauma can influence these feelings.

There's no right or wrong choice. What matters is that you feel informed and supported in your decision.

Making Your Decision: Factors to Consider

Choosing between caesarean section and VBAC requires considering multiple factors. Here's what to think about.

Your Medical History

Your previous caesarean details matter enormously. The type of uterine incision (horizontal versus vertical), reason for the caesarean, and how long ago it occurred all influence your suitability for VBAC.

If your caesarean scar is less than 18 months old, VBAC carries three times the rupture risk compared to longer intervals. However, VBAC may still be possible with appropriate monitoring.

Current Pregnancy Factors

Your current pregnancy's progress influences the decision. Factors like baby's size and position, your health, and whether complications have developed all play a role.

If you need labour induction, this slightly increases uterine rupture risk. Spontaneous labour offers the best VBAC success rates.

Your Future Family Plans

If you're planning more children, this matters. Multiple caesareans increase risks of placental complications, surgical difficulties, and other problems. Successful VBAC reduces these future risks.

The Royal College of Obstetricians and private Gynaecologists in London notes that women seeking multiple future pregnancies should carefully consider that repeat caesareans expose them to greater surgical risks.

Hospital and Provider Capabilities

Not all hospitals offer VBAC services. You need a facility with immediate access to emergency caesarean, blood transfusion, and anaesthetic services. The myGynaePlus team works with facilities equipped for both planned caesareans and VBAC support, ensuring you have access to whatever option you choose.

Your Personal Preferences

Your feelings matter. Some women strongly prefer avoiding surgery if possible. Others find the predictability of planned caesarean reassuring. Neither choice is wrong.

Discuss your concerns, fears, and hopes with your healthcare provider. Good obstetric care respects your preferences whilst ensuring safety.

The Success Factors for VBAC

If you're considering VBAC, certain factors significantly improve your chances. Women with previous vaginal delivery, particularly previous successful VBAC, have the highest success rates.

Other positive factors include maternal age under 40, BMI under 30, baby weighing less than 4kg, and labour starting spontaneously rather than being induced. VBAC calculators exist to estimate your individual success likelihood, though these provide guidance rather than guarantees.

What Happens During Labour with VBAC?

If you're planning VBAC, you'll labour in a hospital where emergency caesarean is immediately available. You'll be advised to contact the hospital as soon as labour starts or your waters break.

Once regular contractions begin, you'll receive continuous electronic foetal monitoring. This tracks your baby's heart rate for early signs of any problems. You can still use various pain relief options, including epidural.

Your care team monitors labour progress carefully. If labour slows significantly or concerns arise about you or baby, they may recommend proceeding to caesarean.

Benefits of Successful VBAC

When VBAC succeeds, benefits include avoiding surgery and its associated risks like infection and blood loss. Recovery is faster, hospital stays are shorter, and you can care for your newborn and other children more easily.

Future pregnancies carry fewer risks after successful VBAC compared to repeat caesareans. You're also more likely to achieve vaginal birth in subsequent pregnancies.

Benefits of Planned Caesarean

Planned caesareans offer certainty about your baby's birth date, which helps with practical arrangements. You avoid labour completely, which some women prefer, especially after traumatic previous experiences.

The risk of uterine rupture is lower with planned caesarean (about 1 in 1,000 compared to 1 in 200 with VBAC). For some women, particularly those with medical complications, planned caesarean is the safest option.

Getting Support at myGynaePlus

At myGynaePlus, we provide comprehensive obstetrics care supporting your choices throughout pregnancy and birth. Our specialists take time to review your medical history, discuss your options thoroughly, and develop a personalised birth plan that prioritises your safety and preferences.

Whether you're preparing for your first delivery or considering options after previous caesarean, our curated services offer complete, transparent care. We understand that each pregnancy journey is unique, and we're here to guide you without rushing you.

Conclusion

Deciding whether to have a caesarean section or trial of labour (VBAC) is a personal decision that depends on many factors. Both are safe if chosen wisely. A caesarean section allows you to plan the day and time of delivery but you will miss out on labour. You will recover faster after a VBAC, but may face higher risks if you have future pregnancies. Your medical history, pregnancy, future pregnancy plans and personal preferences all play a part.

The most important thing is that you have access to factual information and medical advice from a team that will support you and your decision. Here at myGynaePlus we can help you weigh up your options and provide you with evidence-based recommendations from our team of experienced Obstetricians.

If you are pregnant for the first time or considering birth after caesarean (VBAC), make sure you seek the support you need. Take time to go over your options with your doctor/midwife. Don’t be afraid to ask questions and trust your instincts when you make your decision.

Frequently Asked Questions

Can I have VBAC if I've had two previous caesareans?

Yes, VBAC after two caesareans is possible for carefully selected women. Success rates are about 71%, slightly lower than after one caesarean. The uterine rupture risk is higher at approximately 1.36%. You'll need detailed counselling with a senior obstetrician to discuss your individual risks, benefits, and likelihood of success. This decision requires careful consideration of your medical history and future pregnancy plans.

How soon after a caesarean can I safely attempt VBAC?

Ideally, allow at least 18 months between births. VBAC attempted within 18 months carries three times the uterine rupture risk compared to longer intervals. However, timing under 18 months doesn't automatically exclude VBAC. Discuss your specific situation with your healthcare provider, who can assess your individual risk factors and help you make an informed decision about timing and birth method.

What are the signs of uterine rupture during VBAC labour?

Warning signs include sudden severe abdominal pain, abnormal foetal heart rate patterns, vaginal bleeding, and loss of contractions. This is why continuous electronic foetal monitoring is standard during VBAC labour. Healthcare teams are trained to recognise these signs early and respond immediately with emergency caesarean if needed. Most uterine ruptures are identified and managed before serious complications develop for mother or baby.

Does labour induction affect VBAC success rates?

Labour induction slightly reduces VBAC success rates and increases uterine rupture risk. Natural, spontaneous labour offers the best outcomes. If induction becomes medically necessary, certain methods carry different risk levels. Your healthcare provider will discuss the safest induction approach for your situation or may recommend planned caesarean if induction risks outweigh benefits. Many women successfully achieve VBAC after induction.

How do I prepare for a successful VBAC?

Preparation starts with thorough counselling about your individual success likelihood and risks. Maintain healthy weight throughout pregnancy, as obesity reduces VBAC success rates. Consider attending antenatal classes focused on VBAC. Choose a hospital with immediate emergency caesarean access. Stay flexible, understanding that emergency caesarean may become necessary. Good preparation includes practical plans for both vaginal birth and possible caesarean, ensuring you feel ready for either outcome.