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


There has been continued debate about defining an acceptable caesarean delivery rate and what rate achieves optimal maternal and infant outcomes. The overall caesarean delivery rate in England for 2012–2013 was 25.5%; the majority were emergency (14.8%) rather than elective (10.7%) caesarean births. The caesarean delivery rates for Wales, Northern Ireland and Scotland in 2012–2013 were 27.5%, 29.8% and 27.3% respectively. Hence, counselling women for and managing birth after caesarean delivery are important issues.

There is a consensus (National Institute for Health and Care Excellence [NICE], Royal College of Obstetricians and Gynaecologists [RCOG], American College of Obstetricians and Gynecologists [ACOG]/ National Institutes of Health [NIH] that planned VBAC is a clinically safe choice for the majority of women with a single previous lower segment caesarean delivery. Such a strategy is also supported by health economic modelling and would also at least limit any escalation of the caesarean delivery rate and maternal morbidity associated with multiple caesarean deliveries. This guideline provides evidence-based recommendations on best practice for the antenatal and intrapartum management of women undergoing planned VBAC and ERCS.

COVID disclaimer

This guideline was developed as part of the regular programme of Green-top Guidelines, as outlined in our document Developing a Green-top Guideline: Guidance for developers (PDF), and prior to the emergence of COVID-19.

Version history

This is the second edition of this guideline.

Please note that the RCOG Guidelines Committee regularly assesses the need to update the information provided in this publication. Further information on this review is available on request.

Developer declaration of interests

Available on request.

This page was last reviewed 01 October 2015.