Vaginal birth after caesarean section: why and how?

Vidyadhar B. Bangal, Satyajit Gavhane, Vishesha Yadav, Kunal Aher, Dhruval Bhavsar


Background: With the significant rise in the incidence of primary caesarean section(CS) for various indications, an increasing proportion of the pregnant women coming for antenatal care, report with a history of a previous CS. This necessitates definite need to bring down the caesarean section rate, either by judicious selection of cases for primary caesarean section or by attempting vaginal delivery, following previous caesarean section (VBAC).

Methods: A prospective observational study was conducted to find out the success of VBAC and the common predictive factors leading to successful VBAC. A total of 136 pregnant women with full term pregnancy, having history of previous one lower segment caesarean section and without any other medical and obstetrical complication were enrolled in the study.

Results: Majority of the women (95.59%) had spontaneous onset of labor. The success of VBAC was 75 percent. The commonest maternal complications were fever (7.35%), scar dehiscence (3.68%), PPH (1.47%) and wound infection (2.21%).There was significantly higher number of women who had history of previous successful VBAC, had vaginal delivery (91.67%; p=0.038).It was observed that the rate of vaginal delivery was significantly high in women with Bishop’s score between 10 to 13 (94.64%) compared to 6 to 9 (61.25%) (p<0.001).The baby weight determined by ultrasound scan was significantly associated with mode of delivery (p=0.049).

Conclusions: Vaginal Birth After Caesarean section is relatively safe, provided it is conducted in carefully selected cases, under constant supervision. Spontaneous onset of labour, good Bishops score and average baby weight were good predictors of successful VBAC.


Rupture uterus, Scar dehiscence, Trial of labor, Vaginal birth after caesarean section

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American College of Obstetricians and Gynaecology (ACOG). ACOG Practice Bulletin: vaginal birth after previous caesarean delivery: Clinical management guidelines. Int J Gynecol Obstet. 2004;54:197-204.

Cragin B. Conservatism in Obstetrics. New York Med J. 1916;104:1-3.

Khotaba S, Volfson M, Tarazova L, Odeh M, Barenboym R, Fait V et al. Induction of labour in women with previous caesarean section using the double balloon device. Acta Obstet Gynecol Scand. 2001;80:1041-2.

Cunnigham F, Leveno K, Bloom S, Spong CY, Dashe J. Williams Obstetrics. 24th ed. New York: McGraw-Hills;2010.

Sachdeva S, Nanda S, Sachdeva R. Birth audit. J Nat Sci Biol Med. 2013;4(1):155-9.

Mafatlal SJ, Narendrabhai MM. Analysis of mode of delivery in women with previous one caesarean section. J Obstet Gynecol India. 2009;59(2):136-9.

Birara M, Gebrehiwot Y. Factors associated with success of vaginal birth after one caesarean section (VBAC) at three teaching hospitals in Addis Ababa, Ethiopia: a case control study. BMC Pregnancy Childbirth. 2013;13:31.

Stovall TG, Shaver DC, Solomon SK, Anderson GD. Trial of labour in previous caesarean section patients, excluding classical caesarean sections. Obstet Gynecol. 1987;70(5):713-7.

Tahseen S, Griffiths M. Vaginal birth after two caesarean sections (VBAC-2)-a systematic review with meta-analysis of success rate and adverse outcomes of VBAC-2 versus VBAC-1 and repeat (third) caesarean section. BJOG. 2010;117(1):5-19.

Ugwumadu A. Does the maxim once a caesarean, always a caesarean still holds true? PLoS Med. 2005;2(9):e3053.

ACOG Guidelines. Ob-Gyns Issue Less restricitive VBAC guidelines. Washington (DC): American College of Obstetricians and Gynaecologists (ACOG); 2010. Available at

Royal College of Obstetricians and Gynaecologists. Birth after previous caesarean section.Green top guideline No. 45, RCOG press. Feb 2007. Available at

Landon MB, Hauth JC, Leveno KJ, Spong CY, Leindecker S, Varner MW, et al. Maternal and perinatal outcomes associated with a trial of labour among women with prior caesarean delivery. N Engl J Med. 2004;345:3-8.

Cunningham FG, Bangdiwala SI, Brown SS, Dean TM, Frederiksen M, Hogue CR et al. National Institutes of Health Consensus Development Conference Statement: Vaginal Birth After Cesarean Section: New Insights March 8–10, 2010. Obstetric Anesthesia Digest. 2011 Sep 1;31(3):140-2.

Narang H, Singhal S, Ravi V. Assessment of factors individually and as a scoring system in predictive screening for VBAC in patients undergoing trial of labour after single previous caesarean section. IOSR-JDMS. 2014;13(10):109-15.