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 the catastrophe the whole topic is built around.^[12][19]

References20ShowHide

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