1 in 3 UK births are now by caesarean. If you're planning your next birth, VBAC involves a genuine choice — and a conversation worth having with the right information.
If you've had a caesarean before, your next birth involves a genuine choice — and a conversation worth having properly rather than accepting the first recommendation. These five questions give you the framework for making that decision from a position of knowledge.
The overall VBAC success rate is widely quoted as around 72–75% for spontaneous labour in women with one previous caesarean. But this average masks significant variation depending on individual factors.
Success is substantially higher if: you have had a previous vaginal birth (before or after your caesarean), your previous caesarean was for a non-recurring reason (e.g. breach position rather than slow progress), you go into labour spontaneously rather than being induced, your cervix shows signs of readiness before labour starts.
Success is lower if: you have had two or more caesareans, your previous caesarean was for slow progress or failure to progress, you are being induced, you are significantly post-dates.
Ask your obstetrician for your specific estimated success rate, not just the general statistic. Some hospitals use validated calculators (such as the Grobman calculator) to give personalised estimates. You are entitled to this information.
Uterine rupture — where the scar from the previous caesarean gives way during labour — is the risk most frequently cited to dissuade women from VBAC. It is important to understand what this actually means in terms of probability and consequence.
The risk of uterine rupture in spontaneous labour after one previous lower-segment caesarean is approximately 1 in 200 (0.5%). This doubles to roughly 1 in 100 with induction using oxytocin (the hormone drip), and is higher with prostaglandin induction. It does not occur in planned repeat caesarean.
If rupture does occur, it is a genuine emergency requiring immediate surgical intervention. The risk of baby harm from rupture during monitored VBAC in hospital is real but small — the same source quotes approximately 1 in 10 uterine ruptures resulting in infant brain injury or death. In absolute terms: roughly 1 in 2,000 VBAC labours. This needs to be weighed against the risks of repeat caesarean, which are not zero either: longer recovery, greater surgical risk for future pregnancies, placenta complications increasing with each caesarean.
The framing of the VBAC decision often centres on the risks of VBAC relative to caesarean, which feels safer because it is planned. But repeat caesarean has its own risks that deserve equal consideration.
For this pregnancy: longer recovery than a vaginal birth, higher risk of haemorrhage than for a planned first caesarean (due to scar tissue), higher chance of bladder or bowel adhesion complications.
For future pregnancies: each additional caesarean increases the risk of abnormal placental attachment (placenta accreta spectrum) — a serious and increasing problem in UK maternity care. After two caesareans, the risk is around 0.1–0.3%; after three, around 0.6–0.8%. If you want more children, this matters.
VBAC also carries benefits beyond avoiding surgical risk: faster recovery, lower infection risk, higher rates of successful breastfeeding, lower risk to the baby's respiratory system at birth.
VBAC labours are monitored with continuous CTG (cardiotocography) — continuous electronic fetal monitoring throughout active labour. This is the standard recommendation in UK guidelines because changes in fetal heart rate pattern can be an early indicator of uterine scar stress.
Continuous CTG limits mobility compared to intermittent monitoring. You will be connected to monitors and less free to move around. This is worth knowing in advance, and worth discussing with your midwife if mobility and movement in labour are important to you. Wireless CTG monitors exist and are available in some (not all) UK hospitals — worth asking about.
VBAC is typically recommended in a consultant-led unit with immediate access to theatre. Home birth and birth centre VBAC are discussed case by case and require a specific conversation with your obstetric team.
The VBAC conversation in UK maternity care is improving but remains inconsistent. Some women are encouraged towards VBAC as the default; others face pressure towards repeat caesarean. Neither should be your default without a proper discussion of your individual circumstances.
If your initial conversations haven't felt balanced, you have options: ask for a second opinion from a consultant obstetrician or consultant midwife who specialises in birth after caesarean. The charity AIMS (Association for Improvements in Maternity Services) provides information and advocacy support. The RCOG patient leaflet on birth after caesarean is the evidence-based reference point — read it before your appointments.
The decision is yours. Neither VBAC nor planned repeat caesarean is inherently the right choice — the right choice is the one that makes sense for your specific history, family plans, and values, made with complete information.