VBAC Explained
Current Guidance Update
Planned VBAC Success
Planned VBAC in appropriate candidates has a 72–75% success rate, with an estimated uterine rupture risk of approximately 0.5% (1 in 200).
TOLAC Recommendation
A Trial of Labour After Caesarean (TOLAC) should be offered only at institutions capable of performing an emergency caesarean section within 30 minutes.
VBAC Counselling
Women with one previous lower-segment caesarean scar should be counselled that VBAC is a safe option when no contraindications are present.
Shared Decision Making
Delivery planning should involve individualized risk assessment, informed counselling, and shared decision-making to achieve the safest maternal and neonatal outcomes.
Introduction
VBAC & Repeat Caesarean Guide
VBAC Success Rates
Overall success rates are approximately 72–75% in appropriately selected candidates.
Benefits of Planned VBAC
Avoids surgical risks associated with repeat caesarean.
Faster maternal recovery after successful vaginal birth.
Reduced placenta praevia and accreta risk in future pregnancies.
Prevents additional uterine scarring.
Risks of VBAC
Uterine rupture risk approximately 0.5% with spontaneous labour.
Risk increases to 0.7–0.9% with oxytocin augmentation.
Misoprostol induction is generally contraindicated.
Continuous CTG monitoring is mandatory throughout labour.
Contraindications
Previous classical uterine incision.
Previous uterine rupture.
Three or more previous caesarean sections.
Contraindication to vaginal delivery.
No emergency caesarean facility available.
Repeat Elective Caesarean
Elective repeat caesarean avoids uterine rupture risk but carries increasing surgical risks with each operation, including placenta praevia, placenta accreta spectrum disorders, and bladder or bowel adhesions.
Frequently Asked Questions
How many caesareans can I have safely?
There is no absolute limit, but risks increase with each caesarean, particularly placenta accreta spectrum and surgical complications after 2–3 procedures.
Is VBAC allowed in Dubai?
Yes, in appropriate clinical settings with emergency caesarean capability.
Will I need continuous monitoring during VBAC labour?
Yes, continuous CTG monitoring throughout VBAC labour is mandatory to detect early signs of scar compromise.
Conclusion
VBAC is a safe, evidence-based option for the majority of women with one previous lower-segment caesarean scar. Thoughtful, individualised counseling by an experienced obstetrician is the foundation of this decision.
Sources & References
This article draws on guidance current at the time of writing from the following bodies and publications:
- RCOG GTG 45 (2015, reconfirmed 2023)
- ACOG Practice Bulletin #205 (2024)
- FIGO (2023)
General reference bodies for women's health guidance:
RCOG
rcog.org.ukACOG
acog.orgFIGO
figo.orgWHO
who.intNICE
nice.org.uk⚠ IMPORTANT DISCLAIMER
This article is provided for general knowledge and reference purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. No medication, treatment, or change to your healthcare should be undertaken based on this content without first consulting a qualified doctor. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
Consult Dr. Ruby Rashmi
Specialist Obstetrician & Gynecologist, Dubai
