Giving Birth Vaginally After a C-Section. What Should I Choose?Is it Safe? (VBAC VS Repeat C-section, Evidence & Guidance)

Anne Matei
Dec 23, 2025
6 min read

Updated: 3 hours ago

anne matei VBAC doula berlin — photo credit drenginsarica

Not an easy choice

For many parents, pregnancy after a cesarean brings a ton of questions:“Can I give birth vaginally this time?”“What’s safest for me and my baby?”“How do I decide when both choices feel so big (and maybe scary)?”

When you had a previous c-section, your uterus has a scar, Hence, the main concern with a "VBAC" (Vaginal Birth After C-section) is usually uterine rupture. But really, what are the risks? the pros and cons of both options?

As a doula, I am not a medical professional. I will never tell anyone what is safe/unsafe, good or bad for them. But I encourage you getting informed and talking to your medical care team openly about your preferences and fears, to make an informed decision.

Making an informed decision

Initially, you will need to discuss with a gynaecologist and (often) get an ultrasound and a look at your medical history and history of past births, to determine your eligibility for a TOLAC which is a "trial of labour after cesarian" = trying for a vaginal birth after a past C-section. Most women are eligible for a TOLAC and often have two options:

Plan a repeat C-section
- Repeat C-section usually avoids the risk of rupture of the uterus (and brings predictability, but it is major surgery with its own challenges for healing, bonding, and future pregnancies.
TOLAC (Trial of Labour After Cesarian) leading to VBAC (Vaginal Birth After Cesarean)
- This option offers the chance to experience labor and often a faster recovery, less surgery, and fewer risks in future pregnancies. But it does carry a small risk of uterine scare rupture, which can become an emergency, however this risk is about 0.5%.

A successful vaginal birth after a previous cesarean section is associated with the lowest complication rate (DGGG official guideline)

But what matters most is that you feel informed, supported, and respected in your choice, and understand what this means for your under your own medical circumstances (yours/baby's)

What really helps in making the decision

What can support you taking your decision is:

Access to clear, unbiased information — not pressure, fear ... get facts not opinions!
Supportive care providers who will answer your questions honestly.
A safe birth setting where you feel well and safe, with skilled providers supporting VBAC are by your side
Space to listen to your own heart: your values, your previous birth story, and your hopes for this birth.

Here is a wonderful worksheet that can help you balance your own pros and cons. Use this as a talking point to talk to your medical care team.

What the guideline from the German college of Obstetrics say

The Leitlinie (Guideline) from DGGG (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe) says the following, based on systematic evidence review and structured expert consensus:

The overall success rate for vaginal birth after cesarean section is approximately 75% (60–85%).
The pregnant woman should be informed that a successful vaginal birth after a previous cesarean section is associated with the lowest complication rate.

Maternal mortality is higher for elective repeat cesarean section than for planned vaginal birth. However, the absolute risk remains extremely low for both modes of delivery.
The pregnant woman should be informed that, after an unsuccessful trial of vaginal birth, an acute or emergency cesarean section may occasionally become necessary, which is associated with a higher complication rate.
The pregnant woman should be informed that the risk of uterine rupture during vaginal birth after a previous cesarean section is approximately 0.5–1%.
The pregnant woman should be informed that the risk of birth-related perinatal death during vaginal birth after cesarean section is extremely low overall.

Find the Decision That is Right for YOU!

💜 This is a highly personal decision.

💜 What matters most is that you are the one making the decision.

Current ethical guidelines in maternity care recommend that your care providers give evidence-based information about your birth options early in your pregnancy. Speak to your midwife/gynaecologist about it.

Your care provider should explain the benefits and risks of VBAC compared to a routine repeat cesarean and then respect the informed decision you ultimately make. You can find all Berlin birth setting here.

Finding the right birth setting for your VBAC

In Berlin, many clinics support VBACs and also some Geburtshaüser (birth centers) for example if you had a break of 2 years between C-section and due date of next baby, some Geburtshaus will be able to take you in. An other option might be to hire a Beleghebamme.

Contact different birth settings, ask to meet them, tell them about your story, wishes, questions. This is the best way for you to get a sense of where , how and with whom you want to give birth.

Remember that you can ask for a Geburtsplannung consultation to have a 1-1 time with an obstetrician to discuss these. This is billed to your insurance as an outpatient hospital consultation, and clinics usually require an Überweisungsschein (often with a short note like “Geburtsplanung bei Z. n. Sectio”).

Here are some inspiration questions that you may ask when discussing VBAC at the birth settings you are considering.

What is your clinic’s approach to vaginal birth after cesarean (VBAC)?”
Do you routinely support trials of labor after cesarean (TOLAC), and under which conditions?
What is your rate of successful VBAC vs repeat C-section?
How do you support VBAC projects practically?
What are the potential long-term and short-term risks of having a repeat Cesarean for myself and my baby?
If I have a repeat Cesarean, how will this impact future pregnancies and births?
Due to what complications or at what point would you recommend a repeat Cesarean?
How often do you have patients with a uterine rupture? How do you manage this risk? What was the outcome?
What is your philosophy on inductions for VBACs?
Which induction methods do you use for VBAC?
How do you feel about VBACs going beyond 41 weeks? (here the point is to talk about inductions, for VBACs it's ideal to not get an induction as these may interfere with natural hormonal process, and should therefore be approached carefully).
What is your philosophy on waters being broken for more than 24 hours without labour starting? (this is called "PROM" and is a major cause for inductions...)
How long do you think it’s safe for planned VBACs to labor?
What are your thoughts on movement during labor and delivery positions?
Is continuous CTG mandatory for VBAC, and are there options for mobility? Are wireless CTG monitors available?

You may also have a range of more specific questions based on your situation e.g. for breech babies: Do you support vaginal breech birth for patients planning VBAC?,

or for gestational diabetes or suspected big babies; Do you support planned VBACs in patients with Gestational Diabetes? etc.

Don't hesitate to ask all your questions, rephrase what the doctor tells you to make sure you understand, bring some notes and even some evidence to discuss etc. This is your body, your baby, your birth so make sure you feel that your questions were answered.

Now that you have all these discussion points, you can roughly identify each birth setting's culture, between

Non-supportive: Encourages repeat Cesarean over VBAC
Tolerant: Says yes to VBAC, but expresses many conditions or has a high Cesarean rate.
Supportive: Fully supports VBAC and works with you to achieve your desired birth as long as medically safe.

Most providers do not fall into a category of 100% VBAC supportive or 100% VBAC tolerant. Think of it more like a sliding scale from 1-10, with one being the least supportive and ten being the most supportive.

Each provider will have some aspects of VBAC that they are more particular about, and that is not necessarily a red flag. The key is to find a provider as close to being a ten as possible with few, if any, things they are particular about.

Some 🚩 Red flags 🚩 to watch out for:

“We don’t really encourage VBAC in general”
“VBAC is allowed, but only if labor starts spontaneously and progresses fast”
“We try, but most end in cesarean anyway”
Vague answers without numbers or criteria, fear-mongering not based on facts

Green flags, a birth setting where the professionals:

Normalise VBAC as a standard option
Consider your unique birth history, pregnancy, and preferences.
Express clear criteria and individualised counselling
Go over the risks of VBAC and repeat Cesarean equally.
Encourage movement and being upright, especially in early and active labor.
Encourage you to have your doula by your side

Get support from a doula

✨ Evidence shows that having a doula can increase the chance of a successful VBAC and reduce the need for another cesarean.

As your doula, I offer more than emotional support during birth, I also provide a listening ear as you weigh your options, so you feel truly heard and never alone in making these big decisions