Previous Caesarean section or previous surgical scar on the uterus

The risks in this current pregnancy are higher if there was a previous Caesarean section compared to if there was a previous successful vaginal delivery. These include slightly increased risks of rare complications which include:

a) uterine rupture especially during labour

b) placenta accreta where the placenta in the current pregnancy may be low-lying and also invade into the uterine scar. In this situation, there could be excessive bleeding at the time of delivery

c) unexplained stillbirth in the current pregnancy

The options of mode of delivery include:

1) Elective Caesarean section (see risks of Caesarean section in the Mode of Delivery section)

2) Vaginal Birth After Caesarean Section (VBAC). There are 3 possible outcomes for attempting this mode of delivery.

a) Successful vaginal birth

b) Failed vaginal birth resulting in emergency Caesarean section usually because of signs of fetal distress during labour or signs of poor progress during labour.

c) Uterine rupture during labour which is rare, occurring in less than 1% of VBACs, but with potentially serious complications (e.g. death or brain damage of the baby, and hysterectomy / removal of the womb being necessary in some cases of uterine rupture). The percentages of successful vaginal birth / failed vaginal birth / uterine rupture in a VBAC may differ according to the different circumstances in each individual case.

A proper discussion with the obstetrician is required to decide on the mode of delivery.