Can you have a natural birth after a caesarean?

If you want a natural birth, don’t let a previous caesarean stop you. 

13 November 2017
3 minute read

Mother holding new-born baby

The blog is part of our Weaving Wisdom series aimed at informing expectant parents about birth choices and encouraging proactive management of both the pregnancy and birth periods. 

Byline: Louïne van der Vyver and Karin Steyn

There is a rising number of Facebook support groups for moms in our country who want a normal birth after their first caesarean (C-section). This is an indication of the need South African women feel to steer away from what has become a standard medicalised and clinical hospital experience, to something more natural.

Birth can be an empowering experience for both mom and baby. Unless there are complications, birth is not an illness, disease or medical event. It is an involuntary process, like breathing.


Learn more about VBAC (Vaginal Birth After Caesarean) from our expert midwife, Henny de Beer, who wrote her midwifery Masters thesis on VBACs, and recently helped set up the Origin Family-orientated Maternity Hospital in Cape Town:

Why should I consider a VBAC? A successful vaginal birth (even after a C-section) has fewer complications than having an elective C-section.

Natural birth has many wonderful benefits for both mother and baby.

Natural birth has many wonderful benefits for both mother and baby, like the powerful release of oxytocin (the love hormone) that creates a strong foundation for immediate bonding after birth, easier breastfeeding, less chance of baby blues, and a better bond in the long term. The massage of the lungs when exiting the birth canal helps to expel any excess mucus and fluids from your baby’s lungs, resulting in better life-long respiratory health and less chance of developing asthma. The mom’s vaginal flora has a probiotic effect on the baby, aiding its immune system. These are only some of the reasons why natural birth is best in an uncomplicated pregnancy and labour.

Did you know:

  • 70% of women who previously had a C-section can achieve a successful TOLAC (Trial of Labour after caesarean).
  • It is important that labour progresses naturally for a VBAC (no inductions or other interventions).
  • If there is any indication that the labour is not normal (slows down or there are signs of baby being stuck) the VBAC will be stopped.

Why is birthing at a midwifery-led birth unit so important to having a successful VBAC?A birthing centre offers the balance between a home setting, and private and government hospital.

  • During pregnancy the woman starts to plan for her birth and creates the team that will support her needs for training, support, health management and preparation for the birth. She feels like part of a team that she can trust and she is the central person in that team. This removes some of the anxiety and fear that may be harmful during labour.
  • Women are only admitted when they are in labour. This reduces the risk of unnecessary interventions.
  • It already makes a difference the moment the parents enter the building that it does not look or smell like a hospital. The parents are met by friendly people who are less formal or task-oriented and more person-centred, and who are aware that it is a birth and not a procedure. Moms are not required to undress and put on hospital gowns, they do not have to shave and have enemas unless this is what they choose to do. They do not have to fill in lots of forms or sit in a public area where they feel exposed.
  • Early labour is nurtured, because this is the stage where the hormones that support the mom in the labour process, are built up.
  • Best practice is recommended, such as movement during labour and examinations, delayed cord clamping whereby baby benefits from the extra oxygen and red blood cells it receives from the cord blood, skin-to-skin bonding practices and following the nine instinctive stages of successful latching and breastfeeding.
  • If you are supported in a normal birth, birth outcome statistics indicate very few complications for mom and baby.

How do you assess the mother’s suitability for a VBAC? You carefully look at the mother’s history and assess:

  • The reason for her previous C-section.
  • How the previous C-sections were done (for instance, which way did the previous cut run?)
  • Was the baby preterm or term? The size of the scar is larger with preterm babies because the uterus was smaller at the time.
  • Did the mother have an infection in the scar?
  • What was the delivery interval between the C-section baby and the VBAC baby? It should not be less than 18 months.
  • Maternal age. Over 40 years is considered a higher risk factor.
  • The predicted weight of the baby. Over 4kg is considered a risk factor.
  • The BMI (Body Mass Index) of the mother. BMI over 30 is considered a risk factor.

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