VBAC or repeat caesarean: navigating the “what ifs” at the end of pregnancy

VBAC or repeat caesarean: navigating the “what ifs” at the end of pregnancy

As women approach the final weeks of pregnancy, even the most confident and well-researched birth plan can begin to feel uncertain. For those planning a Vaginal Birth After Caesarean (VBAC), it’s not uncommon to feel a strong pull in another direction – toward a scheduled repeat caesarean – simply because it feels more familiar, more predictable, and less risky in the moment.

This shift in thinking doesn’t mean you’re being indecisive or weak. It means you’re human – and you’re trying to make the best decision possible for you, your baby, and your future.

The comfort of the known vs. the fear of the unknown

Many women find comfort in the idea of a planned caesarean because it offers structure and a clear timeline. Particularly if their first birth involved an unplanned caesarean, they may feel that choosing a repeat caesarean is a way to regain control and avoid uncertainty.

VBAC, by comparison, can feel full of unknowns – especially if spontaneous labour and vaginal birth weren’t part of the first experience. While the body is capable, and the evidence supports VBAC as a safe and reasonable option for many, the unpredictability of labour can trigger doubt, anxiety, and fear.

A look at the risks on both sides

One of the biggest concerns for women planning a VBAC is the risk of uterine rupture. While this complication is rare, it is often highly publicised and can feel frightening. The risk of rupture after one previous low transverse caesarean is generally around 0.4% to 0.9%.

That means over 99% of women do not experience a rupture.

Still, when you’re the one making the decision, even small numbers can carry weight.

On the other hand, it’s important to understand that repeat caesareans also come with risks – especially if you’re planning more children. Each additional caesarean increases the chance of:

• Placenta accreta or previa

• Bladder or bowel injury

• Surgical adhesions

• Infection or haemorrhage

• Longer recovery time

• Increased likelihood of hysterectomy in subsequent births
• For women planning three or more children, VBAC can be a way to reduce long-term complications associated with multiple abdominal surgeries.

Decision fatigue in late pregnancy

Decision fatigue is real. After months of reading, preparing, and planning, the end of pregnancy can bring an emotional crash. You might suddenly feel unsure about your choices or notice that your confidence in a VBAC has started to fade – even though your circumstances haven’t changed.

This shift doesn’t mean you’re making the wrong choice. It means you’re navigating a complex emotional landscape while carrying the weight of responsibility for yourself and your baby.

What to do if you’re feeling torn

If you’re currently feeling unsure about whether to proceed with a VBAC or opt for a scheduled caesarean, here are some steps that may help you find clarity:

Talk to a birth professional you trust.
Whether it’s your midwife, doctor, or a doula, find someone who understands VBAC and can walk through your concerns without judgment.

Go back to your original intention.
Ask yourself: what drew you to want a VBAC in the first place? Do those reasons still matter to you?

Visualise both outcomes.
How do you imagine feeling after each type of birth? What would bring you peace, both in the short term and in the future?

Consider your future family plans.
If more children are part of your journey, weigh the short-term relief of a scheduled caesarean against the long-term risks of multiple surgeries.

Look at how you’re feeling—not just what you know.
Sometimes, it’s not about statistics or outcomes, but about how you feel in your body and mind. Trust that your emotional wellbeing is an important part of this decision.

There is no right or wrong — only what feels right for you.
There is no one-size-fits-all answer. Some women go ahead with a VBAC and feel incredibly proud and strong. Others choose a repeat caesarean and feel calm, relieved, and confident in that choice. What matters most is that you make the decision that feels safest, wisest, and most aligned with your values and goals – not one that’s based on pressure, fear, or someone else’s expectations.

 

VBAC is not a test you have to pass.

Caesarean is not a failure.

Birth is complex, deeply personal, and worthy of respect in all its forms.

If you’re currently navigating this choice, know that you are not alone. You deserve support, reliable information, and a safe space to explore your options without fear or judgment.

To learn more about VBAC preparation, birth planning, and holistic support, visit www.backtobasicsbirthing.com.au or contact me directly at [email protected]

You are the expert on your body, your baby, and your birth.

Trust yourself.