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Birth after Previous Caesarean Birth (Green-top Guideline No. 45)

Published: 01/02/2007

This is the first edition of this guideline.

Update November 2014: This guideline is currently being revised, with publication anticipated late 2015. The version available on the website and app will remain valid until replaced.

There is widespread public and professional concern about the increasing proportion of births by caesarean section. Increasing rates of primary caesarean section have led to an increased proportion of the obstetric population who have a history of prior caesarean delivery. Pregnant women with a previous section may be offered either planned vaginal birth after previous caesarean section (VBAC) or elective repeat caesarean section (ERCS). The proportion of women who decline VBAC is, in turn, a significant determinant of overall rates of caesarean birth.

New evidence is emerging to indicate that VBAC may not be as safe as originally thought. These factors, together with medico-legal fears, have led to a recent decline in clinicians offering and women accepting planned VBAC in the UK and North America. This guideline presents the best available evidence to facilitate antenatal counselling in women with prior caesarean birth and to inform the intrapartum management of women undergoing planned VBAC. Prior to this guideline, the National Collaborating Centre for Women’s and Children’s Health (NCC-WCH) clinical guideline, Caesarean Section, published in April 2004, provided the only UK-generated guidance on the management of childbirth after caesarean. This guideline supports the recommendations made in the NCC-WCH guideline but addresses VBAC in more detail.