Birth options after a caesarean section

If you have had a caesarean section, you will need to decide how to give birth next time. You can choose between a vaginal birth after caesarean (VBAC) or an elective repeat caesarean section (ERCS). Both options will have benefits and risks for you and your pēpi.

On this page

Deciding how to give birth after a caesarean

If you have had a caesarean section, you will be referred for a consultation with an obstetrician during your next pregnancy. At the consultation, they will ask you about your general health and your previous pregnancies. They will want to know:

  • why you had your previous caesarean
  • what type of cut was made in your uterus
  • how you felt about your previous birth
  • if you are having any problems or complications with this pregnancy
  • if you are worried about anything.

You and your midwife or doctor will decide whether a vaginal birth or a caesarean will be best. Your decision will be guided by what you want to happen and whether you plan to have more tamariki.

Vaginal birth after caesarean (VBAC)

You are more likely to have a successful vaginal birth after a caesarean if:

  • you have had a previous vaginal birth
  • your labour starts naturally before 41 weeks gestation
  • your pre-pregnancy body mass index (BMI) was less than 30
    Calculate your BMI
  • you are under 35 years old
  • you keep to a healthy weight gain during pregnancy.

VBAC is normally an option for most women. But it is not recommended if:

  • you have had 3 or more caesarean deliveries
  • your uterus ruptured during a previous birth
  • one of your previous caesarean deliveries was a 'classical' (where the scar runs up and down rather than across your lower tummy)
  • you have other pregnancy complications that require a planned caesarean
  • you have had uterine surgery and have been advised not to be in labour.

Trial of labour

A trial of labour is when you attempt to give birth vaginally after a caesarean. When you are in labour, you and your pēpi will be monitored closely to check your labour is progressing safely. You can choose to have an epidural for pain relief.

It is best to give birth at the hospital, so you can quickly have a caesarean if you need one.

Your chances of having a successful vaginal birth after a caesarean are:

  • around 3 in 4 (75%), if you have had a straightforward pregnancy and go into labour on your own
  • around 9 in 10 (90%), if you have previously had a vaginal birth
  • around 7 in 10 (70%), if you have had 2 caesareans before.

If you do not go into labour

If you do not go into labour spontaneously by 41 weeks, your midwife or doctor will discuss the options with you. These will be:

  • continue to wait for labour — it is recommended that you have your baby by 42 weeks
  • induce labour — this increases the risk of your scar weakening and lowers your chance of having a vaginal birth
  • have a elective repeat caesarean section.
Open all

A successful vaginal birth has fewer complications than an elective repeat caesarean section. If you choose to have a VBAC, the advantages include:

  • a faster recovery time
  • a shorter hospital stay
  • a higher chance of skin-to-skin contact with your pēpi immediately after birth
  • breastfeeding is more likely to be started in the first hour after birth
  • avoiding the risks of surgery such as blood loss and infection
  • you newborn pēpi has less chance of having difficulties such as breathing
  • your pēpi is less likely to develop asthma, type 1 diabetes and obesity later in life
  • a higher chance of vaginal birth in future pregnancies.

There are some risks involved with labour and a VBAC. You need to balance these against the risks of having another caesarean.

Needing a caesarean during labour

About 1 in 4 women who go into labour after a previous caesarean, will need a caesarean for the current birth. Sometimes this will be an emergency. But this risk is only slightly more than if it was your first time giving birth (1 in 5, or 20%). It usually happens because your labour is slowing, or the obstetrician is worried about you or your pēpi.

Blood transfusion and infection in the uterus

Compared with women who choose a planned caesarean, you have a slightly higher (1%) chance of needing a blood transfusion or getting an infection in your uterus.

Scar weakening or scar rupture

There is a very small chance that the scar on your uterus will weaken and open before birth. This happens in very few women (about 1 in 200, or 0.5%). If the scar opens completely (ruptures) this can be serious. Being induced increases the chance of this happening. Monitoring your pēpi closely during labour can help detect signs of problems. If there are signs of problems, you will have an emergency caesarean.

Risks to your baby

The risk of your pēpi dying is very small and the same as if you were a first-time mother in labour — just 2 in 1,000, or 0.2%. But it is slightly higher than if you have a planned caesarean, when the risk is 1 in 1,000, or 0.1%.

Elective repeat caesarean section (ERCS)

You are likely to be encouraged to have a vaginal birth after a caesarean. But some women will be advised to have a caesarean for their next pregnancy.

Open all

The advantages of having an ERCS include:

  • smaller risk of uterine scar rupture
  • avoids the risks of labour and the rare risks to your pēpi
  • tubal ligation can be done at the same time as a caesarean if you want permanent contraception.

  • scar tissue in your uterus increases your chances of placenta problems including placenta previa in your next pregnancy
    Placenta previa
  • a repeat caesarean may be more difficult and take longer than the first operation due to scar tissue
  • increased risk of bladder and bowel damage during the operation
  • increased risk of blood clots including a deep vein thrombosis (a complication of any surgery)
    Deep vein thrombosis (DVT)
  • a longer recovery time and you will not be able to drive for about 6 weeks after birth
  • increased risk of your new born pēpi having breathing problems, but this does not usually last long (between 3 and 4 pepi out of 100 born by planned caesarean have breathing problems compared with 2 to 3 out of 100 born by vaginal birth
  • 1 or 2 pēpi out of 100 may receive accidental cuts during the caesarean, but these are usually minor and heal without further harm.

When you plan an ERCS but go into labour

About 10% of women who plan an elective caesarean go into labour. If you go into labour, phone your midwife or doctor. It is likely that you will still have a caesarean if it is safe to do so.

Going into labour

If your labour is very advanced, or if it is early (before 37 weeks), then it may be better to continue with labour. The obstetrician from the birthing suite will discuss this with you.