“Once a caesarean, always a caesarean” is an old saying that still shapes many family conversations in India. Modern guidance from the Royal College of Obstetricians and Gynaecologists (RCOG), ACOG and FOGSI says otherwise. For most women who have had one caesarean with the usual low transverse cut on the uterus, planning a vaginal birth in the next pregnancy is a reasonable and safe choice - provided labour happens in a hospital equipped to monitor it closely and to perform an emergency caesarean if needed.
Planning a VBAC is a decision, not a test you pass or fail. Both a planned VBAC and a planned repeat caesarean have benefits and risks, and the right choice depends on your history, your current pregnancy and your own priorities.
How often does VBAC succeed?
Overall, about three out of four women who plan a VBAC give birth vaginally. The chance is higher in some situations and lower in others.
- Higher chance: a previous vaginal birth, especially a previous VBAC; labour that starts on its own; the first caesarean done for a reason that is not repeating, such as a breech baby or fetal distress
- Lower chance: the first caesarean was for labour that did not progress; labour needs to be induced; a BMI above 30; a baby expected to be large; pregnancy beyond 40 weeks
- Your doctor can give you a more personal estimate after reviewing your previous operation notes
Who is usually suitable
- One previous caesarean with a lower segment (low transverse) incision on the uterus
- At least 18 months between the previous caesarean and the expected date of delivery
- A single baby lying head down
- A placenta that is not low-lying and not attached to the scar
- No other reason that would require a caesarean in this pregnancy
VBAC is generally not advised if you have had a classical (vertical) incision on the uterus, a previous uterine rupture, three or more previous caesareans, or a placenta praevia. With two previous caesareans, VBAC may be considered in selected cases after detailed counselling. Bring your previous discharge summary and operation notes to the first visit - the type of uterine incision is often written there, and it is the single most important piece of information.
The main risk: scar rupture
The concern with VBAC is that the scar on the uterus may open during labour. This is called uterine rupture. With one previous low transverse caesarean, it happens in about 1 in 200 women in labour. It is uncommon, but when it happens it can be serious for both the mother and the baby, which is why VBAC is planned only where continuous monitoring, an operation theatre, anaesthesia, blood bank and a neonatal team are available at all times.
The risk of rupture is higher if labour is induced or augmented with medicines, especially prostaglandins, and if the gap since the last caesarean is short. Induction can still be considered in some cases, with careful discussion.
During a VBAC labour, tell the team immediately if you have constant pain over the scar that continues between contractions, sudden bleeding, a feeling of something giving way, dizziness, or if the baby’s movements change. These can be signs of scar rupture and need immediate assessment.
Comparing VBAC and planned repeat caesarean
- A successful VBAC avoids major abdominal surgery, usually means a shorter hospital stay and quicker recovery, and makes future pregnancies simpler
- Each repeat caesarean increases the risk of placenta accreta, adhesions and bladder or bowel injury in future pregnancies, which matters if you plan more children
- A planned repeat caesarean avoids the small risk of scar rupture and the uncertainty of labour, and can be scheduled
- An emergency caesarean during a VBAC attempt carries somewhat higher risks than either a planned caesarean or a successful VBAC
- For the baby, a planned caesarean has a slightly higher chance of breathing difficulty at birth; VBAC has a very small risk linked to rupture
What a VBAC labour looks like
The aim is for labour to start naturally. You are advised to come to the hospital as soon as contractions begin or the waters break, rather than waiting at home for longer as you might in a first labour.
- Continuous monitoring of the baby’s heart rate (CTG) throughout labour
- An intravenous line and blood tests on admission
- Regular checks of progress; if labour slows or stops, a repeat caesarean may be advised
- Epidural pain relief is available and is not a reason to avoid VBAC
- You can usually move, change position and have a birth companion with you
If labour has not started by around 40 to 41 weeks, the options - waiting longer with monitoring, a gentle induction method, or a planned caesarean - are discussed with you.
Preparing during pregnancy
- Share your previous operation notes early in pregnancy
- Keep weight gain within the recommended range and stay active
- Discuss your options at around 28 to 34 weeks so you have time to decide
- Confirm the placental position on the anomaly scan and, if needed, a later scan
- Agree a plan for what happens if labour does not start by a certain date
When to see a doctor
If you are considering VBAC, book a counselling visit early in pregnancy, ideally in the first trimester. During pregnancy, contact the hospital immediately with contractions, leaking fluid, bleeding, pain over the scar, or reduced baby movements. Divine Women’s Hospital, Gota provides labour and emergency obstetric care 24 × 7, and Dr. Devang Patel discusses the option of VBAC with each woman based on her own history.
Related care: Normal delivery and VBAC (vaginal birth after caesarean)
More patient guides
- The NT scan at 11–14 weeks: what it checks and how to prepare
- High blood pressure in pregnancy: the warning signs you should not wait on
- Expecting twins? Why “do they share a placenta?” is the first question
- NIPT or NT scan: which test do you need, and can one replace the other?
- Pregnancy after 35: fertility, risks and how to plan a healthy pregnancy
This guide is general information for patients and does not replace a consultation with your own doctor.