Practice 10-Minute Consultation

Birth options after a caesarean section

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.j5737 (Published 11 January 2018) Cite this as: BMJ 2018;360:j5737
  1. Jane E Norman, professor of maternal and fetal health, vice principal people and culture, honorary consultant obstetrician12,
  2. Sarah J Stock, senior clinical lecturer, honorary consultant and subspecialist in maternal and fetal medicine1 2
  1. 1Tommy’s Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
  2. 2Royal Infirmary of Edinburgh, Edinburgh, UK
  1. Correspondence to J E Norman jane.norman{at}ed.ac.uk
  • Accepted 4 December 2017

What you need to know

  • Either vaginal birth or elective repeat caesarean section are reasonable options, and adverse outcomes are rare in most uncomplicated pregnancies in women with a previous caesarean section

  • Around 50% of women with one previous caesarean section attempt a vaginal birth in their second pregnancy, and of these nearly two thirds are successful

  • Explore the woman’s concerns, preferences, reasons for previous caesarean section, and plans for future pregnancies to inform the choice of mode of delivery

A 30 year old woman at 36 weeks’ gestation in her second pregnancy asks about her options for delivery. Her previous baby was born by emergency caesarean section at 39 weeks, after breech presentation was diagnosed in labour.

Birth options after an earlier caesarean section include

  • • A trial of labour after caesarean: allowing spontaneous labour to occur, anticipating a vaginal delivery (known as vaginal birth after caesarean section, or VBAC)

  • • Planned elective repeat caesarean section (ERCS).

Both are reasonable options for most women. The rates of serious maternal and neonatal adverse outcomes with either of the strategies are low.1 Pregnancy complications might alter the risks and benefits of each delivery strategy. ERCS is recommended in some scenarios (box 1), but an exploration of the woman’s wishes and shared decision making is vital. Women attribute different values to the benefits and risks of either approach. Studies from the UK and US show that around 50% of women attempted a vaginal birth after one previous caesarean section.456

Box 1

Indications for elective caesarean section23

Fetal complications

  • Breech presentation at term; offer elective caesarean section if external cephalic version is unsuitable or unsuccessful

  • Other non-vertex presentations, including transverse lie

  • Twin pregnancy if the first twin is breech

Maternal complications

  • Placenta praevia (covering or less than 2 cm from the …

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