VBAC Rates-and Why Who Cares Matters

When it comes to VBAC (Vaginal Birth After Caesarean), the numbers tell a powerful story. It’s a story of systems, models of care and the voices that shape a woman’s journey and choices.

In 2018, VBAC attempt rates across developed countries varied dramatically- from just 4.7% in Cyprus to 55% in Finland (Keedle, 2022, p. 31) In England and Wales this figure sits at 38%. This insight shows us that something must be influencing whether women attempt a VBAC or choose an Elective Repeat Caesarean Section (ERCS)

It's important to distinguish between the attempted VBAC rate (how many women plan to try for a vaginal birth) and the overall VBAC rate (how many actually give birth vaginally after a caesarean, including those who planned repeat caesareans from the start).

Even in the UK, where care might be expected to be more standardised, overall VBAC rates vary widely from one hospital trust to another. While older figures (from 2018/2019) placed the national average at around 20%, more recent data from January 2025 shows that actual VBAC rates now range from as low as 5% to as high as 35% across different trusts, with a current national average closer to 12%. This overall VBAC rate is comparable to countries like the United States and Australia, where rates sit around 14% (Keedle, 2022, p. 31)

If you're planning a VBAC, it can be helpful to look up your local hospital’s VBAC rate using available tools- because where you plan to birth can make a bigger difference than many realise.

So the real question isn’t just can a woman have a VBAC, but rather: What kind of system is she being asked to do it in?

Caesarean Scar

A Brief History of VBAC: How We Got Here

For much of the 20th century, VBAC wasn’t even part of the conversation. The phrase “once a caesarean, always a caesarean” summed up the prevailing medical approach. Back then, caesareans were rare and if you had one it was assumed you’d always need one.

That belief wasn’t plucked from nowhere. In the early part of the century, factors like rickets (which could deform the pelvis) and vertical “classical” uterine incisions, which carried a higher risk of rupture, made repeat caesareans a safer bet under the conditions of the time. So if a woman had truly needed a caesarean back then, it was likely she'd need one again.

But as medical knowledge and surgical techniques evolved, so too did the conversation.

From the 1970s onward, things began to shift. In the U.S., as caesarean rates started to rise sharply, the idea of VBAC gained traction- especially through the 1980s and early 1990s. Women were actively encouraged to try for a vaginal birth after caesarean. But many of those VBACs were induced and at the time we didn’t fully understand how induction could increase the risk of uterine rupture.

Then came a turning point: in 1999, the American College of Obstetricians and Gynaecologists (ACOG) introduced a guideline stating that anesthesia must be “immediately available” during a VBAC. On the surface, that sounds reasonable- but in practice, it created a major barrier. Many hospitals, especially smaller or rural ones, couldn’t meet that standard 24/7.

At the same time, malpractice insurance premiums were climbing, and the perceived legal risks of attending VBACs became too high for many providers. The result? VBAC rates plummeted. Some hospitals formally banned them. Others stopped offering them simply because no doctors were willing to attend.

Meanwhile, in the UK, a similar trend emerged. In just a two year period between 2000 and 2002, VBAC attempt rates dropped from 48% to just over 30%- despite success rates staying high, around 73%. The issue wasn’t that VBAC stopped working. It’s that fewer women were being supported to try.

This history shows something critical: a woman might be willing and she might be a great candidate. But if the infrastructure, policies or perceptions aren’t in place to support her choice, that choice effectively disappears.

The Power of the Care Model—and the Voices That Shape It

A fascinating UK-based study really brings this home. It found that the model of care a woman receives can significantly influence not just her choices around birth, but her actual outcome:

• 90% of women receiving midwife-led antenatal care planned to attempt a VBAC, compared to 77% of those in obstetric-led care.

• 61% under the midwife-led antenatal care model went on to have a vaginal birth, versus 47% under obstetric-led care.

  
  

And here's what’s key: the women themselves were broadly similar- same age, background, and medical circumstances. The national VBAC rate across England didn’t shift during the study period, so this wasn’t due to broader cultural change either. The difference came down to the care they received antenatally.

Planning a VBAC in a midwifery-led setting isn’t just about antenatal care- there is also research to support the power of midwife-led care over obstetric care during birth. A review of high-quality research found that women who planned their VBAC in midwifery-led settings were significantly more likely to have an unassisted vaginal birth and less likely to need an emergency caesarean or instrumental birth compared to those in obstetric-led care. Importantly, there were no significant differences in adverse outcomes like uterine rupture or low Apgar scores. This suggests that midwifery-led care during VBAC can offer safe and positive birth experiences with fewer interventions.

an example of a typical midwife led unit/ birth centre

These studies shine a spotlight on a truth we don’t talk about enough: The beliefs and attitudes of the people guiding your care throughout your pregnancy and birth can profoundly shape your birth choices and outcomes.

The global evidence echoes this pattern:

• In a Chinse study, VBAC success rates was 88% with continuity of care, compared to 68% under standard care.

• In an Australia study Australia, women under midwifery care were more confident in their body’s ability to birth and more likely to experience labour in water and active birth.

Different Roles, Different Philosophies: Midwives vs Obstetricians

Midwives are experts in physiological birth. In the UK, they are university-educated professionals trained to support the biological, psychological, and cultural processes of childbirth. Midwives are typically responsible for the majority of antenatal, intrapartum, and postnatal care. While they are skilled in supporting 'normal' birth, they are also trained to recognise complications and escalate care appropriately when needed.

Obstetricians, on the other hand, are medical doctors who specialise in managing the complications of pregnancy and birth. They are usually involved when a pregnancy is considered "high risk" or when something deviates from the expected course. As a result, they rarely witness physiological births- particularly those that take place in birth centres or at home. I once heard an obstetrician say that the first 'normal' birth she ever witnessed was her own, in a midwife-led unit. Her husband, a paediatrician, said the same. That speaks volumes.

This difference isn’t about one being better than the other- it’s about understanding that each model of care is built on a different philosophy. Midwifery tends to view childbirth as a normal life event that occasionally needs medical support. The obstetric lens, by contrast, is more likely to see birth as a medical event that requires active oversight to manage risk.

Of course, these perspectives exist on a spectrum- t5he real world isn’t black and white. But when you’re navigating birth after caesarean, understanding these differences can help you reflect on your own beliefs, birth philosophy, values, tolerance to risk and in turn the kind of support that aligns with them.

The Voices Around Us

When making choices about birthing after caesarean, our emotions aren’t just shaped by clinical facts or the opinions of professionals. They are deeply influenced by the wider culture and the support networks around us.

Many still view a repeat caesarean as the “safe” or “sensible” choice. That old phrase, “once a caesarean, always a caesarean,” dates back to 1916, but it still holds power in the stories we hear today. These stories often lack nuance and are rooted in fear, outdated information and societal assumptions.

In the UK, our birth culture is one where medicalised birth is the default. Physiological birth (especially after a caesarean) is rarely witnessed, whether by professionals, families, or communities. So VBAC can feel unfamiliar and even risky, even though the evidence tells a more nuanced story.

Research shows that the attitude of birth partners can significantly impact whether a woman plans a VBAC or not. If your partner associates caesarean with safety, predictability, or control, this can impact your likelihood of planning a VBAC. And while those fears often come from a place of love, they can become yet another layer of resistance a woman must push through to uncover how she truly wants to birth after caesarean.

That’s Where Doulas Come In

A doula doesn’t replace your partner, your midwife, or your consultant. A Doula's role is to work alongside them by providing complementary emotional, practical and informational support.

For someone planning a VBAC, especially in a system or social environment that feels uncertain or unsupportive, this kind of continuous, grounded support can be transformative. When the world is full of noise, fear, and conflicting messages, a doula can help you stay centred and connected to what matters most to you.

The research backs this up: Having a doula present has been shown to reduce the likelihood of a caesarean, decrease epidural and other pain relief use, shorten labour, and reduce the length of hospital stays. It’s also linked to greater confidence in both birthing and parenting, improved emotional wellbeing, and more positive birth experiences overall.

“If doulas were a drug, it would be unethical not to use them.”

What Do You Believe Is Possible?

Birth is about more than your body. It’s about your beliefs, the care model you’re in, and the culture you’re birthing within. It’s about who you’re listening to and who’s really listening to you.

So when planning a VBAC, the question isn’t just “Am I allowed?” or “Am I able?” It’s:

• What do I believe is truly possible for my birth?

• What kind of care aligns with what I believe about birth?

• Who do I want walking that path with me?

• Do I have the support I need to birth on my own terms?

References and Further Reading

Keedle, H. (2022).Birth After Caesarean: Your Journey to a Better Birth. Praeclarus Press