The FIGO Committee on Childbirth and Postpartum Haemorrhage has released evidence-based recommendations to guide care around vaginal birth after caesarean section (VBAC), published in the International Journal of Gynecology & Obstetrics (IJGO).
With caesarean section (CS) rates rising globally – projected to reach nearly 30% by 2030 – there is growing attention to VBAC as a safe and effective alternative to repeat CS in appropriately selected women. In many regions, particularly urban areas, primary CS on maternal request is becoming more common, often supported by obstetricians. This trend has prompted renewed focus on strategies to reduce unnecessary repeat surgeries and associated risks.
While CS can be life-saving, CS does carry short- and long-term risks for the mother, baby and subsequent pregnancies. These include significantly higher rates of severe maternal morbidity – such as haemorrhage, uterine rupture, anaesthetic complications, thromboembolism and infection – compared with vaginal birth.
VBAC offers the benefit of avoiding repeat surgery and its associated risks. The newly published guidance emphasises thorough patient counselling, highlighting four key elements:
- Individualised risk of uterine rupture
- Personalised assessment of VBAC success likelihood (or risk of intrapartum CS)
- Future reproductive plans
- Patient preference
These components are designed to facilitate informed, patient-centred decision-making and account for the complexities and sensitivities of VBAC care.
This paper brings together the best available evidence regarding VBAC, supporting obstetricians to provide safer, more personalised care for women in all settings around the world.
– Dr Alison Wright, co-author
VBAC success rates typically range from 60% to 80%. While uterine rupture remains the main concern, its risk is low – estimated at 0.3% to 0.7% for women with one prior low transverse CS. Studies show that VBAC is associated with comparable or better outcomes than planned repeat CS, including lower maternal mortality, fewer infections and shorter hospital stays.
This evidence-based guidance aims to lower risks associated with CS and increase VBAC success rates. The paper provides key recommendations to support and promote VBAC. This is highly relevant – especially in LMIC areas where access to skilled staff and operating facilities may be limited.
– Dr Eytan R. Barnea, lead author
The article emphasises appropriate patient counselling, facility readiness for emergency CS and close foetal monitoring during labour. The paper emphasises that measures to safely increase VBAC rates should be implemented globally, both to stem the increasing tide of CS rates and to ensure that women are able to make truly informed decisions.
Access the full article here.