Factsheet: Vaginal Birth After Caesarean: options, success rates, what improves success, and why it matters

Abbie Tomson

Continuity of carer Midwife in the NHS and All4Birth Lead

@all4birth

Summary

• VBAC is a clinically safe option for many after one previous LSCS, and overall success is ~72–75%.

• A prior vaginal birth is one of the strongest positive predictors (often ~85–90% success).

• Uterine rupture risk is about 0.5% (1 in 200) for planned VBAC.

• UK audit data shows fewer people are currently attempting VBAC — worth exploring what support and options are realistically available locally.

What does VBAC mean?

VBAC = Vaginal Birth After Caesarean.
It usually refers to planning a vaginal birth after one previous lower-segment caesarean (LSCS), though VBAC after two caesareans exists and needs more individualised counselling ¹

Why consider VBAC?

People consider VBAC for lots of reasons, including:

• Wanting the experience of vaginal birth

• Shorter recovery for many (though not all)

• Avoiding cumulative risks that can increase with multiple caesareans (important if you hope for a bigger family)

• Reduced risk of surgical complications in future pregnancies compared with multiple repeat caesareans (discussed in RCOG counselling)

RCOG emphasises that successful VBAC is associated with the fewest complications ¹

VBAC success rates: what does the evidence say?

Overall success (if you plan VBAC)

RCOG reports the chance of a successful planned VBAC is around 72–75%. ¹

What’s happening in the UK right now (latest audit data)

The National Maternity and Perinatal Audit (NMPA) State of the Nation (births in 2023) reported:

• Only 14.2% of births after a previous caesarean were vaginal (VBAC)

• The proportion of ‘eligible’ women/birthing people who try for VBAC has fallen to 26.3% (down from 40% in 2016/17) ²

That’s not the same thing as “success rate”, but it highlights a real-world shift in access, counselling, confidence, service capacity, and support.

What increases the chance of a successful VBAC?

Evidence and guideline counselling consistently support higher associated success when:

• You’ve had a previous vaginal birth (especially a previous VBAC): success is often quoted around 85–90% ³

• Labour starts spontaneously (rather than through induction of labour)

• There is no recurrent indication (e.g., last CS for a non-recurring reason such as breech)

• Healthy BMI and good mobility can help (though VBAC is absolutely still possible across BMI ranges)

VBAC risks

Uterine rupture

RCOG states planned VBAC carries about a 1 in 200 (0.5%) risk of uterine rupture. ¹

Risk varies with:

• Induction/augmentation

• Type of uterine scar

• Interval since last birth

• Individual clinical factors

“The highest risk scenario”

RCOG highlights that the greatest risk of adverse outcome occurs when a planned VBAC ends in an emergency caesarean, which is why personalised counselling matters. ¹

Induction in a VBAC pregnancy

Sometimes induction is offered in a VBAC pregnancy (e.g., post-dates, PROM, maternal/baby concerns), but method matters.

NICE notes that some prostaglandins (the pessary or propess, prostin gel) are contraindicated with a uterine scar in certain contexts; VBAC induction of labour guidelines typically favour mechanical methods (such as a balloon induction) and amniotomy (artificial rupture of membranes), depending on local policy and individual factors. ⁴