Vaginal Birth After Multiple C-Sections – Is It Safe?

Vaginal Birth After Multiple C-Sections – Is It Safe?

Maternity care experts now believe that a vaginal birth after c-section (VBAC) is a safe option for most women and their babies.

But what about women who’ve had two or more c-sections who want a vaginal birth?

Women wishing to try a vaginal birth after two c-sections are generally ‘not allowed’, or are advised that there’s a greater risk of complications, and less likelihood of success.

They might even be made to feel that choosing a VBAC is dangerous or irresponsible.

However, a review of available evidence shows a different story.

The success rate for women who attempted a VBAC after 2 c-sections was found to exceed 71%, while the uterine rupture rate was around 1.3%. The risk of complications was similar to those of a repeat c-section.

A 2010 study compared risks and success rates from a group of over 25,000 women who had prior c-sections and were attempting a VBAC. The women who had three or more prior c-sections had similar rates of success and complications as those with one prior c-section, and as those born by elective repeat c-section.

Another study confirms the risk of uterine rupture is no greater in women who have multiple c-sections, and shows the overall risk of any complications is very small.

Benefits of VBAC After Multiple C-Section

The benefits of VBAC are the same for women, regardless of how many c-sections they’ve had.

A vaginal birth after c-section:

  • Reduces the risk associated with c-section surgery (infection, blood loss etc)
  • Has a shorter recovery time than a c-section
  • Gives women a greater sense of satisfaction with their birth experience
  • Reduces the baby’s risk of breathing issues that require admission to NICU
  • Means your baby has chosen his or her birth date, based on when he or she was ready

Women who try for a VBAC only to require a c-section often report feeling a greater sense of control and empowerment, because they were able to make informed decisions about their birth experience. They felt they did everything they could, and surgery was truly needed.

Is VBAC After Multiple C-Section A Good Choice for Me?

When discussing whether a VBAC is a good option for you, bear in mind that many doctors may be reluctant to consider vaginal birth after multiple c-section. Choosing a supportive maternity care provider is key to ensuring you are making an informed decision about your baby’s birth.

Your chances of success for VBAC is rated higher if:

  • Your previous c-section scar is from a low transverse incision (side to side incision in the lower part of your uterus).
  • You’ve had a previous c-section for a reason that is unlikely to be repeated (breech position, diagnosis of failure to progress, placenta previa etc).
  • You have already had one vaginal birth before or after your last c-section
  • You and your baby have no medical complications
  • Your labour begins spontaneously (without being induced)
  • Your baby is in a good position (head down and facing forwards or anterior)
  • Labouring freely without constraint on movement

Most hospitals require constant monitoring of the baby in case of distress, which is a sign of possible uterine rupture. Continuous fetal monitoring (CFM – where there are belts strapped around your belly) means you are restricted in movement during labour, which can lead to labour slowing down and stalling. There has been no reliable evidence to show (CFM) improves VBAC outcomes.

The Cochrane review of continuous electronic fetal monitoring found that it is not more effective at picking up distress in babies than intermittent monitoring. The review also showed that CFM increases the number of unnecessary c-sections carried out, which can reduce that chance of a successful VBAC.

Some hospital criteria for VBAC focus on baby’s size and the body weight of the mother. There is currently no evidence to show a large baby requires a c-section, unless during labour complications arise, such as true cephalopelvic disproportion (when the baby’s head is too large to fit through the pelvis).

Women with a BMI of over 30 (obese) are usually told they cannot try for a VBAC because they are more likely to have medical complications during pregnancy and more likely to go past estimated due dates. While obesity during pregnancy increases the chances of c-section, it also increases the risk of C-section complications, such as wound infections. You should discuss your health and particular situation with your doctor if your BMI is 30 or over, to determine if VBAC is the best choice for you.

Why Not A Repeat C-Section?

Women who’ve had multiple previous c-sections may be advised by their doctor to schedule a repeat c-section for future pregnancies. It’s important to understand that a decision to have a repeat c-section should not be taken lightly. Each subsequent surgery becomes even riskier than the previous one.

You are at greater risk of serious complications such as:

  • Severe blood loss (postpartum haemorrhage)
  • Hysterectomy
  • Injury to the mother’s organs and to baby during surgery
  • Blood clots, and bowel obstruction (due to scarring and adhesions from the surgery)
  • Ongoing infections and pelvic pain
  • Ongoing issues for future pregnancies due to your uterine scar causing problems with the placenta.

Tips For A Successful VBAC

Being informed about all the risks and benefits of VBAC, as well as repeat c-section (in relation to your own individual health and situation), is key. Choose a care provider who is supportive of VBAC, and make sure you know how they feel about VBACs after multiple c-sections.

If you are planning a VBAC after multiple c-section, there is no guarantee you will avoid another c-section. But there is a great deal you can do to increase your chances of a successful VBAC. Most importantly, do your research and be as informed as possible during pregnancy, so that there are no surprises.

Choose your caregiver carefully, making sure they support and encourage VBAC as well as value your role as the decision maker in your care. Your care provider should be positive about vaginal birth and available to discuss your options for care and answer your questions. It’s a good idea to review the reasons for your previous c-sections, to understand how you might improve your chances for a successful vaginal birth.

Consider hiring a doula to provide emotional and educational support during pregnancy as well as 1:1 support during labour.

Evidence shows that high risk women who have support during labour from doulas have better birth outcomes.

Recommended VBAC Reading

You need the BellyBelly Birth & Early Parenting Immersion!
MAXIMISE your chances of getting the birth you want… MINIMISE your chances of a disappointing or traumatic birth experience. Feel MORE CONFIDENT heading into birth… GUARANTEED.
  • 264


Sam McCulloch enjoyed talking so much about birth she decided to become a birth educator and doula, supporting parents in making informed choices about their birth experience. In her spare time she writes novels. She is mother to three beautiful little humans.


  1. I want to know how long you can wait to become pregnant after multiple c-sections to be able to have a sucessful vbac

  2. I had 3 c sections an now I would like to have another baby my youngest is 10 I’m only 30 but would it be safe to get a bath birth Icause I do not want a c section I would like to go through all the pain

  3. I’m only 5 weeks and need to find a new obgy or midwife. I’ve had planed 2 c-section. First due to breach and second because it was only 15 months after my first. I’m interested in trying to have a Vbac. It will be 2 1/2 years between my youngest and this. I was told by by old on that I could be a candidate but since moved. Any suggestions on questions to ask when looking for a supportive obyn?

  4. I had 3 c-secions, the last one was in November 2014 and now Im 26 weeks pregnant with my fourth baby,All my C-sections were cut horizontally just below my uterus.
    I really want to try Vbac this time.

  5. Hi, I’m 31years old and have had 3 vaginal and 4 emergency C-sections. One of my natural vaginal happened 3years after my emergency C-section. My last 3 pregnancies were C-sections. It’s been 2 1/2 years since my last C-section and I found out I am pregnant. My first thought was fear of how severe and risky it will be to have the baby; due to the scar tissue I have all over, because of the previous C-sections. After, reading this article I am considering looking into having a vaginal birth, but I need to research more of the health of myself.

  6. I have C- section once and also remove Fibroid 3 years after, I’m currently pregnant can I try Vbac successfully.

  7. I had my first c-section in 2007 my second in 2011 and #3 in 2012 I have always wanted a vaginal birth but haven’t been able to for problems beyond my control I’m healthy and have recently found out that I’m pregnant again.. I was hoping someone could tell me what they thought about a vaginal after 3 c-sections

  8. I have had two c-sections and seriously looking out for vaginal birth. I seriously need advice on what to do to aid cervix dilation, because my first c-section was on undilated cervix and the second was because of baby distress.Right now am pregnant again and I need coaching. Thanks

  9. I want to know how long you can wait to become pregnant after 2 c-sections to be able to have a sucessful vbac l. And is it possible?

Leave a Reply

Please note: in order to prevent spam and inappropriate language, all comments are moderated before they appear. We appreciate your patience awaiting approval. BellyBelly receives many comments every day, and we are unable to approve them all as soon as they are posted.

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

loaded font roboto