Birth choices after a caesarean section

If you’ve previously had a caesarean and are pregnant again, you might have a vaginal birth or another caesarean this time. This might surprise you but most women who have had a caesarean section can safely have a vaginal birth for their next baby (NHS Choices, 2016b). If this is what you choose, you should be fully supported in your choice to have a vaginal birth (NICE, 2013).

On the other hand, you might be advised to have another caesarean, depending on your medical situation and health professionals’ recommendations (NHS Choices, 2016a). Some women prefer to ask for a planned birth by elective repeat caesarean section (ERCS).

Knowing more about your options might help you with your planning if you’re having another baby.

How common is it to have a caesarean and what’s it like afterwards?

• About one in four to five women give birth by caesarean section in the UK. About half of these are planned and half are emergency caesareans.
• For most women who give birth by a caesarean section, it’s a fairly routine procedure with a straightforward recovery.
• Some women find their physical and emotional recovery after a caesarean birth can take longer, depending on their individual circumstances.
• For some women, an emergency caesarean section can be a disappointing or traumatic birth experience. (NHS Choices, 2016; RCOG, 2015a; RCOG, 2016b)

Having a baby is an emotional time but there is plenty of perinatal mental health support available if you need it.

Will I be able to have a vaginal birth in the future?

It’s likely you will be able to have a vaginal birth. Most women can have a vaginal birth safely after previously having a single ‘lower segment’ caesarean (it’s the most common type: lower cut to uterus) (RCOG, 2015b; NHS Choices, 2016b).

Whether you’re able to have a vaginal birth after caesarean (VBAC) depends on medical factors, health professionals’ recommendations and your personal preferences (NICE, 2013; NHS Choices, 2016a).

What is a VBAC?

A vaginal birth after caesarean (VBAC) includes both straightforward vaginal births and those assisted by forceps or ventouse.

What is an ERCS?

An elective repeat caesarean section (ERCS) is a planned caesarean. Women usually have them after 39 weeks of pregnancy (NHS Choices, 2016).

What factors should I consider when planning a VBAC or ERCS?

Planning for a VBAC or choosing an ERCS have different benefits and risks. When considering your options, you’ll need to consider the following factors:

• Why you had a caesarean section before.

• Whether you’ve had a vaginal birth before.

• Whether you had any complications at the time or during your recovery.

• The type of cut that was made in your uterus.

• How you felt about your previous birth.

• Whether your current pregnancy has been straightforward, or if there have been any problems or complications.

• The number of babies you’re hoping to have in future. Some risks increase with each caesarean section so it’s better to try to avoid another caesarean if you’d like more babies.

(RCOG, 2016)

Some factors indicate you might be offered another caesarean, including if you had:

• A previous uterine rupture.
• A previous incision that was not the standard ‘lower segment’ incision.
• Previous uterine surgery.
• Placenta previa – each caesarean birth raises the risk of placenta previa, which is low lying placenta.
• Placenta accreta – each caesarean birth raises the risk of placenta accreta, where the placenta grows into the uterine muscle, making separation during birth difficult.

(RCOG, 2015b)

What are my birth options if I’ve had several caesarean births?

You have a similar risk of uterine rupture with VBAC whether you’ve had one or two previous caesarean births (RCOG, 2015b). Yet you have a slightly increased risk of having a hysterectomy and blood transfusion with a VBAC after two compared with one previous caesarean birth (RCOG, 2015b).

If you’ve had more than one caesarean birth, make sure you discuss with a senior obstetrician the potential risks, benefits and success rates of VBAC (RCOG, 2015b). If you are choosing a VBAC after multiple caesareans, they’ll probably recommended you have your baby in a centre with suitable expertise and access to surgery (RCOG, 2015b).

If you’re still not sure whether you’d prefer to plan for a VBAC or ERCS, it’s worth reading our article about the benefits and risks of VBAC and ERCS. You can also read our articles on planning a VBAC and planning an ERCS, to help you make your mind up.

Do discuss any questions or concerns with your midwife, health visitor or GP.

This page was last reviewed in June 2018

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.