Maternal Outcomes in Vaginal Birth After Cesarean Delivery

Vaginal birth after caesarean delivery (VBAC) offers the potential to reduce maternal morbidity associated with repeat surgical delivery, including haemorrhage, infection and extended hospital stay. Success rates for VBAC vary according to individual clinical factors, but when appropriately selected, many women achieve a safe vaginal outcome. Key determinants of success include prior vaginal birth, favourable cervical status on admission, absence of recurrent indications for caesarean and careful intrapartum monitoring. Nevertheless, VBAC carries a small but serious risk of uterine rupture, which may lead to significant maternal haemorrhage, emergency hysterectomy or intensive care admission. Optimising maternal outcomes requires a multidisciplinary approach that balances the benefits of avoiding repeat surgery against the potential for acute labour complications. Globally, resource-sensitive strategies such as standardised risk assessment tools and clear protocols for labour induction and augmentation are essential to support women’s informed choice and to improve both clinical and cost-effectiveness outcomes.

Research from Nature Portfolio

Recent studies have demonstrated the value of predictive tools to enhance selection for VBAC. One investigation validated an established scoring system, showing that a higher score predicted increased likelihood of vaginal success and may guide counselling in diverse clinical settings. A separate multicountry analysis examined the incidence of uterine rupture among women with prior caesarean in facilities across varying resource levels. This work highlighted how maternal education, spontaneous onset of labour and gestational age under 37 weeks influence rupture risk, and underscored markedly elevated mortality and severe morbidity where emergency surgical capacity is limited.

Maternal Outcomes in Vaginal Birth After Cesarean Delivery publication trend

The graph below shows the total number of articles in maternal outcomes in vaginal birth after cesarean delivery across all publications each year (not limited to Nature Index journals).

Technical terms

Trial of Labour after Caesarean (TOLAC): The attempt to deliver vaginally in a woman who has had a previous caesarean section.

Vaginal Birth After Caesarean (VBAC): Successful vaginal delivery following a prior caesarean section.

Uterine Rupture: A full-thickness tear of the uterine wall during labour, potentially leading to haemorrhage and emergency surgery.

Bishop Score: A numerical assessment of cervical favourability based on dilation, effacement, station, consistency and position.

Flamm and Geiger Score: A predictive algorithm combining obstetric history and current clinical parameters to estimate VBAC success.

Labour Induction: The initiation of uterine contractions through pharmacological or mechanical means before spontaneous labour onset.

References

1. Factors associated with successful vaginal birth after one lower uterine transverse cesarean section delivery. Scientific Reports (2023).
2. Incidence and outcomes of uterine rupture among women with prior caesarean section: WHO Multicountry Survey on Maternal and Newborn Health. Scientific Reports (2017).
3. Risks and Probabilities of Adverse Pregnancy Outcomes in Patients Undergoing Trial of Labor after Cesarean—A Retrospective Study. Diagnostics (2024).
4. Oxytocin use in trial of labor after cesarean and its relationship with risk of uterine rupture in women with one previous cesarean section: a meta-analysis of observational studies. BMC Pregnancy and Childbirth (2021).
5. Factors associated with successful vaginal birth after a cesarean section: a systematic review and meta-analysis. BMC Pregnancy and Childbirth (2019).
6. Predicting Cesarean Section and Uterine Rupture among Women Attempting Vaginal Birth after Prior Cesarean Section. PLOS Medicine (2005).