5 Myths About Having a Vaginal Birth After Caesarean (VBAC)
If you've had a previous caesarean or belly birth, you may have heard the phrase "once a caesarean, always a caesarean." This ridiculous saying, along with many common myths about VBAC (Vaginal Birth After Caesarean), continues to wrongly influence medical care and limit women and birthing people's choices.
As a doula, I want to help you separate fact from fiction so you can make informed decisions about your birth. The truth is, VBAC is not only possible for most women—it's actively supported by leading medical bodies, so let's jump in and find out the real story.
Myth 1: Once a caesarean, always a caesarean.
The Truth: This couldn't be further from reality. VBAC is not an alternative choice—it's a mainstream, evidence-based option supported by decades of research.
“VBAC is a reasonable and safe choice for the majority of people with a prior cesarean. Both VBAC and repeat caesarean have risks and benefits, however hospital policies cannot force women to have caesareans.”
The American College of Obstetricians and Gynecologists (ACOG) echoes this, stating that "most women with one previous cesarean delivery with a low-transverse incision are candidates for and should be counselled about and offered TOLAC (trial of labour after caesarean)."
Most countries around the world have similar recommendations, affirming that VBAC should be available and offered to most women.
Myth 2: VBAC has an extremely high risk of uterine rupture.
The Truth: Some women are told frightening statistics like "60% chance of uterine rupture," which are simply untrue and prevent informed decision-making. One of the most reliable studies reported a uterine rupture rate of 0.40% or 1 in 240 women with one prior low transverse caesarean section during a non-induced or augmented planned VBAC.
That rate of uterine rupture increased to 0.90% when labour was augmented and up to 1% when labour was induced.
To put this into further perspective, any labour is at risk of complications that can require an emergency caesarean.
Yet healthcare providers aren't telling all mothers to have a caesarean just in case they have a placenta abruption, cord prolapse, or their baby experiences shoulder dystocia.
Uterine rupture risk is small, manageable, and hospitals have protocols in place to handle obstetrical emergencies regardless of whether it's a VBAC or non-VBAC.
Myth 3: Repeat caesareans are safer than VBAC.
The Truth: Both VBAC and repeat caesarean carry risks and benefits. While some healthcare providers focus on VBAC risks, repeat caesareans can also come with significant complications that increase with each surgery. Studies have consistently found that successful VBACs have lower maternal complication rates than elective repeat caesarean.
Complications include (but are not limited to):
Placenta accreta spectrum: This is where the placenta embeds too deeply in the uterine wall. The risk increases with each caesarean (especially from the 3rd C-section).
The risks that are associated with having major surgery include blood clots, DVT, and embolism.
Blood loss
Infection and inflammation
Longer stay in hospital
Slower healing
Possible hysterectomy
Interestingly, research shows that maternal death rates are actually five times higher with elective repeat caesarean (0.0134%) compared to planned VBAC (0.0038%), though both rates are very low overall.
Myth 4: Very few women can actually have a VBAC.
The Truth: Most women are excellent candidates for VBAC, especially after one prior caesarean when risks are lowest. Even if you've had two C-sections, you can still consider a VBAC when weighing up the risks against a third caesarean. Current evidence shows that 60-80% of women who attempt VBAC (TOLAC - Trial of Labour After Caesarean) achieve successful vaginal births.
While healthcare providers may have a list of key factors that they believe make someone a good VBAC candidate, the only absolute contraindications to a VBAC are:
Previous uterine rupture
Classical caesarean or T-shaped incision
Three or more previous C-sections
Placenta praevia
Complicated uterine scars
Women who should not be coerced or forced into repeat caesarean:
• Short birth intervals
• 40 plus week gestation
• Suspected macrosomia
• Single versus dual layer suturing
• Thin uterus
• Multiple caesareans.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) states that a woman should be well-informed regarding the mode of birth after a previous caesarean section and has the right to have her wishes respected.
Myth 5: Hospitals ban VBAC because it's too dangerous.
The Truth: Hospital VBAC bans are rarely about safety—they're often about convenience, liability concerns, or lack of provider willingness (and skill). Sometimes the barrier to VBAC is the practitioner's preference. If your healthcare provider will not support your VBAC, it is their duty to find you someone who will. As the Australian Medical Association Maternal Decision-Making Position Statement says,
“9. The doctor must respect the woman’s informed decision, even if it is not consistent with the doctor’s advice, and continue to provide patient support. In the event that the doctor cannot in good faith continue to care for the patient, they have a duty to make timely arrangements for that patient’s ongoing care.”
Don’t be afraid to push back on your care provider with this information. If a VBAC is your choice, it’s their job to them to find someone who will truly support that choice.
Your VBAC Success Tips: Get prepped for the VBAC journey.
If you've decided you want a VBAC, these strategies can help you maximise your chance of success.
Be determined
Your mindset matters enormously. VBAC requires mental strength and unwavering belief in your body's ability to birth vaginally. Cultivate determination by connecting with your reasons for wanting a VBAC—whether it's avoiding surgery risks, experiencing vaginal birth, faster recovery, or protecting future pregnancies. Write these reasons down and return to them when doubts arise. Remember that your determination isn't stubbornness—it's an informed choice based on evidence and your personal values.
Do your research
Knowledge is power in your VBAC journey. Learn about your specific situation. What type of incision did you have? What was the reason for your previous caesarean? Understanding these factors helps you make informed decisions and advocate effectively with your care providers.
Key questions to research and discuss:
Understanding the difference between complete uterine rupture vs. dehiscence (incomplete rupture)
How birth intervals may affect your risk (though evidence is limited)
Why policies and procedures are not law—you always have choices
Your rights to informed consent, including understanding all alternatives, risks, benefits, possible complications, and anticipated results
Ask your hospital for their VBAC and maternity care guidelines so you know their position.
Research current VBAC statistics, success rates, and evidence-based practices. Familiarise yourself with your rights as a patient, including the right to decline surgery even at hospitals with VBAC restrictions. Remember, their guidelines and policies are for them to abide by, not you. They aren’t the law.
Your care provider should inform, recommend, and then support whatever decision you make. Check out the resources section below, which includes links to evidence-based research to get you started.
Trust your body
Your body grew and nurtured your baby—it has the inherent wisdom to birth. The reason for your previous caesarean may not apply to this pregnancy. Many women who had caesareans for "failure to progress" or "too big baby" go on to have successful VBACs. In most cases, these “reasons” are more excuses and are offered because your healthcare provider failed to wait and allow your body to do its thing. Connect with your body through positive birth affirmations, visualisation, and body awareness practices.
Prepare your mind
Mental preparation is as crucial as physical preparation. Use positive birth affirmations specific to VBAC, such as "My body knows how to birth my baby" or "I trust my body's wisdom." Practice relaxation techniques, meditation, and visualisation of your successful VBAC.
Working through any fears that stem from your previous birth experience is critical. Consider working with a counsellor or therapist. Address any worries or anxieties about birth, pain, or complications. Hypnobirthing, meditation apps, and guided imagery can be powerful tools for mental preparation.
Prepare your body
Physical preparation supports your VBAC goals. Maintain a balanced diet throughout pregnancy, focusing on foods that support healing and energy. Stay appropriately active. Research shows that walking three times a week for 40 minutes, starting from week 36 of your pregnancy, can help your baby get into the optimal position. Swimming, prenatal yoga, and pelvic floor exercises are also beneficial.
Practice optimal fetal positioning techniques to encourage your baby into the best position for birth. Consider prenatal massage, chiropractic care, internal release or accupuncture to support physical comfort and optimal positioning.
Build a supportive birth team (Including a Doula!)
Surround yourself with people who believe in VBAC and support your goals. This starts with finding a healthcare provider who is genuinely supportive of VBAC—not just someone who "allows" it but someone who actively encourages and supports your choice. Interview potential providers about their VBAC rates, philosophies, and specific supportive practices.
A doula can be invaluable for VBAC mothers. Research shows that continuous labour support significantly improves birth outcomes, including higher rates of vaginal birth and greater satisfaction with the birth experience. Your doula will:
Provide evidence-based information and help you navigate decisions
Offer emotional support and reassurance throughout labour
Use comfort measures and positioning to support optimal labour progress
Advocate for your preferences and help you communicate with medical staff
Provide continuous support during the vulnerable moments of labour
Help you stay focused on your VBAC goal when challenges arise
If you don't have the budget to invest in a doula, a supportive birth partner is a must. Ensure they are informed about physiological birth and comfort techniques that will support you during labour.
Know that in most cases, a VBAC is a viable option.
Don't let outdated myths or unsupported fears rob you of the birth experience you desire. You have the right to accurate information, supportive care, and respect for your autonomous decisions about your body and your birth.
“You are not just a previous caesarean scar. You are a powerful birthing woman with options, rights, and the incredible ability to bring your baby into this world in the way that feels right for you.”
Your VBAC journey may have challenges, but with proper preparation, support, and evidence-based care, you can approach your birth with confidence and empowerment. Trust in the process, trust in your team, and most importantly, trust in yourself.
If you're considering VBAC and would like supportive, evidence-based guidance throughout your pregnancy and birth, I'd love to discuss how doula support can help you in your VBAC journey. Contact me to learn more about how we can work together.
Resources
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Australian VBAC Stories https://open.spotify.com/show/2qJFwxzzpUQQFjwG98qqwa
https://australianbirthstories.com/podcasts/vbac/
Great Birth Rebellion Episode 157 - VBAC Tips & Tricks
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This blog provides general information about VBAC and does not replace medical advice. It should form part of your research, but it is advised you undertake additional research as well. Always consult with a healthcare professional for personalised advice based on your individual circumstances and medical history.
Contact Kelly
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About Kelly Allen
My name is Kelly, and I’m an emerging birth and postpartum doula who is completing training at the Doula Training Academy. I service women and birthing people in the North Shore of Sydney, helping you enter and emerge from birth and the fourth trimester feeling physically and emotionally well.