Vaginal birth after caesarean section

Caesarean section (CS) has evolved from a procedure with considerable morbidity and mortality risks into one that is safe enough to be considered as a matter of maternal choice in high resource countries. Improvements in operative techniques, anaesthesia, intensive care, blood transfusion services and availability of antibiotics have all contributed to improved safety of the procedure for pregnant women. Rates of CS are rising all over the world and so are the rates of vaginal birth after caesarean (VBAC). Attempting a VBAC is a safe and appropriate choice that must be offered to most women who have had a prior caesarean delivery. Approximately 70–75% of women who attempt VBAC will have a successful vaginal delivery. However VBAC is associated with risks for both mother and the baby. The possibility of uterine rupture in labour ranges from 3 to 7 per 1000 pregnancies while the risk of perinatal death or severe morbidity should uterine rupture occur is higher with trial of vaginal delivery than with repeat caesarean delivery. These risks and the associated medico-legal sequelae have resulted in revised national and international guidelines with focus on antenatal counselling, individualised risk assessment as well as stringent facility and personnel requirements to conduct VBAC.