Birth after caesarean: VBAC and elective repeat caesarean

She is 31, one caesarean at full dilatation three years ago for failure to progress, now 34 weeks and asking the question every antenatal clinic hears: "Can I have a normal birth this time?" You have twelve minutes. The examiner is not testing whether you know the answer — there isn't one — but whether you can hand her real numbers, hear what matters to her, and write a plan that holds up at 3 am when she arrives contracting.^[1][7]

Overview and definition

Get the words right, because examiners listen for them. Planned VBAC and trial of labour after caesarean describe the intention; successful VBAC describes the outcome; elective repeat caesarean is the planned alternative. A woman who plans VBAC and ends up with an intrapartum caesarean has not "failed" — she has had a planned VBAC with a caesarean outcome, and her risk profile sits between the two groups.^[1][11]

The second distinction is surgical. Complete rupture breaches the full thickness of the uterine wall including the visceral peritoneum, with fetal parts or membranes escaping into the abdomen; dehiscence is a scar window with intact peritoneum, usually asymptomatic and often found incidentally at repeat caesarean. Only the first is catastrophe whole topic is built around.^[12][19]

References20ShowHide

1. [1]Landon MB, Hauth JC, Leveno KJ, et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery N Engl J Med, 2004.PMID 15598960
2. [2]Grobman WA, Lai Y, Landon MB, et al. Development of a nomogram for prediction of vaginal birth after cesarean delivery Obstet Gynecol, 2007.PMID 17400840
3. [3]Grobman WA, Sandoval G, Rice MM, et al. Prediction of vaginal birth after cesarean delivery in term gestations: a calculator without race and ethnicity Am J Obstet Gynecol, 2021.PMID 34043983
4. [4]Guise JM, McDonagh MS, Osterweil P, et al. Systematic review of the incidence and consequences of uterine rupture in women with previous caesarean section BMJ, 2004.PMID 15231616
5. [5]Fitzpatrick KE, Kurinczuk JJ, Alfirevic Z, et al. Uterine rupture by intended mode of delivery in the UK: a national case-control study PLoS Med, 2012.PMID 22427745
6. [6]Lydon-Rochelle M, Holt VL, Easterling TR, et al. Risk of uterine rupture during labor among women with a prior cesarean delivery N Engl J Med, 2001.PMID 11439945
7. [7]Crowther CA, Dodd JM, Hiller JE, et al. Planned vaginal birth or elective repeat caesarean: patient preference restricted cohort with nested randomised trial PLoS Med, 2012.PMID 22427749
8. [8]Dodd JM, Crowther CA, Huertas E, et al. Planned elective repeat caesarean section versus planned vaginal birth for women with a previous caesarean birth Cochrane Database Syst Rev, 2013.PMID 24323886
9. [9]Dodd JM, Crowther CA, Grivell RM, et al. Elective repeat caesarean section versus induction of labour for women with a previous caesarean birth Cochrane Database Syst Rev, 2017.PMID 28744896
10. [10]Tita AT, Landon MB, Spong CY, et al. Timing of elective repeat cesarean delivery at term and neonatal outcomes N Engl J Med, 2009.PMID 19129525
11. [11]American College of Obstetricians and Gynecologists ACOG Practice Bulletin No. 205: Vaginal Birth After Cesarean Delivery Obstet Gynecol, 2019.PMID 30681543
12. [12]Al-Zirqi I, Stray-Pedersen B, Forsén L, et al. Uterine rupture: trends over 40 years BJOG, 2016.PMID 25846698
13. [13]Silver RM, Landon MB, Rouse DJ, et al. Maternal morbidity associated with multiple repeat cesarean deliveries Obstet Gynecol, 2006.PMID 16738145
14. [14]Bujold E, Mehta SH, Bujold C, et al. Interdelivery interval and uterine rupture Am J Obstet Gynecol, 2002.PMID 12439503
15. [15]Bujold E, Goyet M, Marcoux S, et al. The role of uterine closure in the risk of uterine rupture Obstet Gynecol, 2010.PMID 20567166
16. [16]Bruno AM, Allshouse AA, Metz TD Maximum Oxytocin Dose and Uterine Rupture During Trial of Labor After Cesarean Obstet Gynecol, 2025.PMID 41325062
17. [17]Mao H, Shen P Trial of labor versus elective cesarean delivery for patients with two prior cesarean sections: a systematic review and meta-analysis J Matern Fetal Neonatal Med, 2024.PMID 38485519
18. [18]Zhang N, Ward H Safety and efficacy of external cephalic version after a previous caesarean delivery: A systematic review Aust N Z J Obstet Gynaecol, 2021.PMID 34169515
19. [19]Opipari A, Singh S, Taylor M, et al. Recognition of intrapartum uterine rupture, anesthetic management, and maternal-fetal outcomes: strategies for rapid response Curr Opin Anaesthesiol, 2026.PMID 42052858
20. [20]Marshall NE, Fu R, Guise JM Impact of multiple cesarean deliveries on maternal morbidity: a systematic review Am J Obstet Gynecol, 2011.PMID 22071057