VBAC | Vaginal Birth After Caesarean Section
Many women who gave birth by caesarean section reach their next pregnancy with one question weighing heavily on their minds:
“Can I give birth vaginally this time?”
In many cases, the answer is yes.
VBAC (Vaginal Birth After Caesarean) is, in other words, a vaginal birth after a caesarean section, and it is a realistic option. It is an evidence-based, safe choice in appropriate cases, with success rates ranging between 70–80%.
In Greece, VBAC remains less common than in other European countries, often due to a lack of information or difficulty finding a doctor who offers it.
Dr Ioannis Douliotis, who trained in the United Kingdom, where VBAC is an accepted practice, actively offers and supports this option.
What are the requirements for VBAC?
Not all cases are suitable, and it is important to know that from the outset. The decision to attempt VBAC is always made on an individual basis, after reviewing the full medical history.
Favorable factors for a successful VBAC:
- The previous caesarean involved a low transverse uterine incision (lower segment incision), the most common modern technique
- There is no history of uterine rupture
- The current pregnancy is progressing without complications
- Normal fetal position
- The reason for the previous caesarean is no longer present (e.g. if it was due to breech presentation, this time the baby is in cephalic position)
- A history of previous vaginal birth – this increases the chance of success to 85–90%
Factors that reduce the chances of success or rule out VBAC:
- Previous vertical uterine incision or T-shaped incision
- History of uterine rupture in a previous birth
- The reason for the caesarean remains (e.g. an anatomical pelvic difference)
- Fetal macrosomia (estimated weight > 4 kg)
- Certain medical conditions in the current pregnancy
How long after a caesarean can I attempt VBAC?
The recommended interval between a caesarean section and the next pregnancy is at least 18–24 months—enough time for the uterine scar to heal fully and to minimize the risk of rupture. This interval refers to conception, not the birth itself.
If the next pregnancy occurs sooner, this does not automatically mean that VBAC is ruled out, but it must be assessed more carefully. The minimum generally acceptable interval between a caesarean section and attempting VBAC is considered to be 12 months—below this threshold, the risk of uterine rupture increases significantly and the decision must be made with particular caution and individualized assessment.
VBAC after two caesareans – Is it possible?
VBAC after one caesarean is the most common and best-documented option. After two caesareans, VBAC is possible in selected cases, but the assessment is stricter and requires an experienced doctor and a properly equipped maternity unit.
The main factor considered is the condition of the uterine scar and the risk of rupture, which, although small, increases slightly with each operation.
What is the VBAC protocol?
A VBAC is not simply a “vaginal birth”; it is a vaginal birth with specialized monitoring. The protocol includes:
During pregnancy:
- Assessment of suitability for VBAC early on, ideally before the 20th week
- Ultrasound evaluation of uterine scar thickness
- More frequent growth scans in the third trimester
- Informing and preparing the couple for all possible scenarios
During labour:
- Continuous cardiotocographic monitoring of the mother and baby
- Immediate access to an operating theatre if an emergency caesarean becomes necessary
- Avoidance of aggressive induction of labour – labour should ideally start spontaneously
The benefits of VBAC compared with a repeat caesarean
When VBAC is successful, the advantages are significant:
- Avoidance of surgery and the complications that can accompany it
- Faster recovery and return to daily activities
- Lower risk of complications in future pregnancies. Repeated caesareans increase the risk of placenta previa and placenta accreta spectrum disorders
- Greater likelihood of vaginal birth in future pregnancies
- For many women, a deeply personal experience they wished to have
The risk of uterine rupture – What you need to know
Uterine rupture, meaning the opening of the scar from the previous caesarean during labour, is the main risk associated with VBAC. However, this risk is very small, around 0.5% in selected cases with a low transverse uterine incision.
Continuous cardiotocographic monitoring during labour allows for the early recognition of any sign of complication, and immediate access to an operating theatre ensures the fastest possible response if needed.
Frequently Asked Questions (FAQ)
Yes, epidural anaesthesia is compatible with VBAC and does not mask the symptoms of uterine rupture as was once believed. Its use is left to the woman’s choice.
If labour does not progress satisfactorily or any concerning sign appears, an emergency caesarean section is performed. This is known in advance and is part of the protocol—it is not a failure, but safe management.
VBAC should be carried out only in a well-organized maternity unit with immediate access to an operating theatre. It is not suitable for home birth or for small centres without the appropriate infrastructure.
Assessment is based on the history of the previous caesarean, the course of the current pregnancy, and certain ultrasound findings. If you are interested, the best first step is to discuss it early, ideally before the 20th week.
VBAC remains less common in Greece compared with countries such as the United Kingdom, where it is considered standard practice. Dr Douliotis, with training and clinical experience in the NHS, actively offers and supports VBAC in suitable cases.
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