Vaginal birth after caesarean section: a cohort study investigating factors associated with its uptake and success

BJOG. 2014 Jan;121(2):183-92. doi: 10.1111/1471-0528.12508. Epub 2013 Nov 20.


Objectives: To investigate the demographic and obstetric factors associated with the uptake and success rate of vaginal birth after caesarean section (VBAC).

Design: Cohort study using data from Hospital Episode Statistics.

Setting: English National Health Service.

Population: Women whose first birth resulted in a live singleton delivery by caesarean section between 1 April 2004 and 31 March 2011, and who had a second birth before 31 March 2012.

Methods: Logistic regression to estimate adjusted odds ratios (OR).

Main outcome measures: Attempted and successful VBAC.

Results: Among the 143,970 women in the cohort, 75,086 (52.2%) attempted a VBAC for their second birth. Younger women, those of non-white ethnicity and those living in a more deprived area had higher rates of attempted VBAC. Overall, 47,602 women (63.4%) who attempted a VBAC had a successful vaginal birth. Younger women and women of white ethnicity had higher success rates. Black women had a particularly low success rate (OR, 0.54; 95% confidence interval [CI], 0.50-0.57). Women who had an emergency caesarean section in their first birth also had a lower VBAC success rate, particularly those with a history of failed induction of labour (OR, 0.59; 95% CI, 0.53-0.67).

Conclusion: In this national cohort, just over one-half of women with a primary caesarean section who were eligible for a trial of labour attempted a VBAC for their second birth. Of these, almost two-thirds successfully achieved a vaginal delivery.

Keywords: Administrative data; England; trial of labour; vaginal birth after caesarean.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Birth Intervals
  • Birth Weight
  • Black People / statistics & numerical data
  • Cohort Studies
  • Diabetes, Gestational / epidemiology
  • Emergencies
  • Female
  • Fetal Membranes, Premature Rupture / epidemiology
  • Humans
  • Logistic Models
  • Pregnancy
  • Trial of Labor
  • United Kingdom
  • Vaginal Birth after Cesarean / statistics & numerical data*
  • White People / statistics & numerical data
  • Young Adult