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Updated: Apr 25, 2026
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Published on: June 6, 2020
Assessing the Balance Between Success and Safety in Trial of Labour After Cesarean
Irina I Oltean1, Rohan D'Souza1, Elizabeth K Darling2
1Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 1280 Main Street West Hamilton, ON; Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, 1280 Main Street West Hamilton, ON.
Abstract:
Attaining a vaginal birth after cesarean (VBAC) is one outcome of electing a trial of labour after cesarean delivery. Mode of birth decision aids use prediction tools focused on success rates, with limited attention to maternal safety. In this population-based study of 230 590 births (2010-2021), 50.9% achieved VBAC, including 13.5% via operative vaginal birth. Severe maternal morbidity rates were comparable between all VBAC and elective repeat cesarean delivery but varied by VBAC mode: lowest after spontaneous vaginal birth and highest after forceps or combined instruments. Counselling should integrate maternal safety alongside likelihood of VBAC.
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