Tommy's PregnancyHub

Pregnancy and giving birth after a caesarean section

If you’ve had a caesarean section and are planning another pregnancy, you may be wondering when to start trying and what your options are for giving birth next time. Here’s more information about pregnancy and birth after a caesarean section.

When can I get pregnant again after a caesarean section?

It’s recommended to wait for about a year after a caesarean section (c-section) before getting pregnant again. Recovering from a caesarean section usually takes longer than recovering from a vaginal birth, even if the birth was straightforward. It’s important to give your body time to recover before you start trying again. The longer you leave your scar to heal, the stronger it will be.

It’s particularly important to make sure your scar has completely healed if you want to try for a vaginal birth next time. This is because it is possible that the scar may open slightly, which is known as uterine dehiscence. This may not cause any serious issues, but it may increase the chance of a uterine rupture (a tear in the wall of the uterus), which can cause serious problems for both the mum and baby. The chances of a uterine rupture is higher if you have a vaginal birth next time, but it is still rare.  

It may help to think about how long it took you to recover following your last c-section, your current physical health now and if you’re feeling emotionally ready. There are lots of positive things you can do to improve your chances of having a healthy pregnancy and baby. Find out more about planning a pregnancy.

Of course, pregnancy isn’t always planned. Or you may want to get pregnant sooner for your own reasons. If you have become pregnant within a year of having a caesarean section, you may still be able to give birth vaginally if you want to. Your doctor or midwife will be able to talk to you about your best options for giving birth.

What are my options for giving birth again after a caesarean section?

You can have a vaginal birth after caesarean (VBAC) or an elective repeat caesarean section (ERCS). If you are fit and healthy, both are safe choices with very small risks.  

What you decide to do will depend on several things. This includes your pregnancy history, your medical history and how your current pregnancy is progressing. 

“I would say listen to your medical professionals and keep an open mind. I wanted a VBAC after a traumatic emergency c-section, several miscarriages and a difficult pregnancy. Unfortunately this didn’t happen but my elective c-section was wonderfully civilised and a complete contrast to the first birth!”
Amanda

Discussions with your midwife and doctor (obstetrician)

Your doctor or midwife will talk to you about your options, ideally before you are 28 weeks pregnant. This may include a conversation about:

  • why you had a c-section last time
  • if you have ever had a vaginal birth 
  • if there were any complications during your last c-section or during your recovery 
  • the type of cut that was made during your c-section surgery (a horizontal cut just below your bikini line or a vertical cut down from your belly button) It is rare to have a vertical incision. 
  • how you feel about your most recent birth experience
  • how your current pregnancy is progressing and if there have been any issues or complications 
  • how many more babies you are hoping to have in the future – the risks increase with each c- section, so if you plan to have more babies it may be better to try to avoid another c-section if possible. 

If you do decide to try for a vaginal birth (VBAC), you will be advised to give birth in hospital. This is so an emergency c- section or a blood transfusion can be carried out if necessary. This is even more important if your labour is induced (started artificially) because the risks of some complications, such as uterine rupture, are higher. 

Will I have to have another caesarean section?

You may be advised to have another caesarean section if you have:

  • a vertical scar on your uterus 
  • placenta praevia
  • had a uterine rupture/dehiscence before
  • had uterine surgery before. 

Can I have a vaginal birth if I have had more than one c-section? 

If you have had more than 1 c-section, you should have the opportunity to talk to a senior obstetrician (doctor) about the potential risks and benefits for you. 

Speak to your midwife as soon as possible to arrange a consultation with an obstetrician.

“I had an emergency c-section with my first rainbow baby. When I fell pregnant with my second, I knew I wanted to try for a VBAC, but I had much more realistic expectations this time as it was a high-risk pregnancy. There was a moment during labour that I thought I would have another c-section, but thankfully I managed a vaginal birth. I did the same with my third and am hoping I can do it again with my fourth. I think every mum who has had a c-section should feel hopeful they can have a VBAC if that’s what they want, but be proud of themselves regardless.”
Cara

What are my chances of having a successful vaginal delivery after a c-section?

After 1 c-section, most women can give birth vaginally (if they have an uncomplicated pregnancy and go into labour naturally). 

There are some things that make a successful vaginal birth more likely. These include if:

  • you’ve ever had a vaginal birth, especially if you’ve had a vaginal birth after a c-section 
  • labour starts naturally
  • you were at a healthy weight when you got pregnant. 

What are the advantages of having a vaginal birth after a c-section?

A successful vaginal birth after a c-section has fewer complications than an elective c-section(ECRS). If you have a vaginal birth:

  • your recovery is likely to be quicker
  • your stay in hospital may be shorter
  • you will avoid the risks of an operation
  • your baby will have less chance of initial breathing problems. 

What are the disadvantages of a vaginal birth after a c-section (VBAC)?

You may need to have an emergency c-section during labour. This happens to around 25% of women.  

Also:

  • you have a slightly higher chance of needing a blood transfusion compared with women who choose a planned caesarean section 
  • the scar on your uterus may separate and/or tear (dehiscence/rupture). This can occur in 1 in 200 women. This risk increases if your labour is induced (started artificially). If it looks like that may happen, you’ll be offered an emergency caesarean section
  • there is a serious risk to your baby such as brain injury or stillbirth is higher than for a planned caesarean section, but is the same as if you were in labour for the first time
  • you may need an assisted birth
  • you may experience a perineal tear involving the muscle that controls the anus or rectum (third or fourth degree tear), which usually associated with an assisted birth. 

What are the advantages of an elective c-section after a c-section (ECRS)?

  • There is a smaller risk of the c-section scar separating or tearing (1 in 1000). 
  • You will know the date of planned birth. Although some women go into labour before this date and sometimes this date may be changed for other reasons. 

What are the disadvantages of an elective c-section after a c-section (ECRS)?   

A repeat caesarean section usually takes longer than the first operation because of the formation of scar tissue. Scar tissue may also make the operation more difficult and can cause damage to your bowel or bladder.

  • You can get a wound infection that can take several weeks to heal. 
  • You may need a blood transfusion. 
  • You have a higher risk of developing a blood clot (thrombosis) in the legs (deep vein thrombosis) or lungs (pulmonary embolism).
  • You may have a longer recovery period and may need extra help at home. You will be unable to drive for about 6 weeks after surgery (check with your insurance company).
  • You are more likely to need a planned c-section in future pregnancies. More scar tissue occurs with each c-section. This increases the possibility of the placenta growing into the scar, making it difficult to remove during any future deliveries. This can cause bleeding and you may need a hysterectomy. This means you will have surgery to remove your uterus and you won’t be able to get pregnant again. The risks of serious problems like this increase with every c-section you have. 
  • Your baby’s skin may be cut accidentally during the c-section. This happens in 2 out of every 100 babies delivered by c-section. This is usually a very minor cut and heals without any further harm. 
  • Breathing problems for your baby are quite common after a c-section but usually do not last long. This risk is slightly higher after a c-section than after a vaginal birth.

Where can I give birth next time?

You are generally advised to give birth in hospital or midwife-led unit.  But where you give birth is ultimately your choice, so speak to your doctor or midwife about what is best for you. 

What happens when I go into labour if I’m planning a vaginal birth after a c-section (VBAC)? 

Contact the hospital as soon as you think you have gone into labour or if your waters break. Once you start having regular contractions, you will be advised to have your baby’s heartbeat monitored continuously during labour. This will help the midwives and doctors keep an eye on your baby’s wellbeing.

You can choose various options for pain relief. Your midwife will be able to explain the different options available to you.

What happens if I don’t go into labour if I’m planning a vaginal birth after a c-section (VBAC)?

Your doctor will talk to you about your options during your pregnancy as part of planning for the birth.

If you don’t go into labour naturally by 41 weeks, your options may include: 

 

  • waiting for labour to start naturally 
  • inducing labour (this can increase the risk of uterine scar rupture and lowers the chance of a successful vaginal birth).

What happens if I have an elective c-section planned but I go into labour? 

Tell your maternity team immediately if you start going into labour. You will likely be offered an emergency c-section, but if labour is very advanced it may be safer for you to have a vaginal birth. 

Your maternity team will discuss this with you. 

Royal College of Obstetricians & Gynaecologists (2016) Birth Options after https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-birth-options-after-previous-caesarean-section.pdf

Bujold E, Gauthier RJ. Risk of uterine rupture associated with an interdelivery interval between 18 and 24 months. Obstet Gynecol. 2010 May;115(5):1003-6. doi: 10.1097/AOG.0b013e3181d992fb. PMID: 20410775.

NHS Choices. Caesarean section. https://www.nhs.uk/conditions/caesarean-section/ (Page last updated 27/06/2019 Next review due: 27/06/2022)

NICE (2011). Caesarean section. National Institute for health and care excellence https://www.nice.org.uk/guidance/cg132/

NHS Choices. Planning another pregnancy. https://www.nhs.uk/conditions/pregnancy-and-baby/planning-another-pregnancy/ (Page last updated 13/07/2020 Next review due: 13/07/2020)

Royal College of Obstetricians & Gynaecologists (2015) Birth After Previous Caesarean Birth. Green-top Guideline No.45 https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_45.pdf

Review dates

Last reviewed: 27 January 2021
Next review: 27 January 2024