Quality Standard Details
Vaginal Birth After Caesarean (VBAC): Care for People Who Have Had a Caesarean Birth and Are Planning Their Next Birth
- Publication Date
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2024-October-01
- Status
- Published
- Topic Area
- Fertility, Pregnancy and Childbirth
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Most people who have had a Caesarean birth can have a VBAC, and a large body of evidence suggests that VBAC is safe for most eligible pregnant people. However, data show that the rate of planned VBACs has decreased over time in Ontario, from 41.0% in fiscal year (FY) 2014/15 to 39.0% in FY 2022/23, while the rate of planned elective repeat Caesarean births in Ontario for FY 2022/23 was 56.1%.
People considering planned VBAC need to balance the overall benefits (such as faster recovery time, lower risk of abnormal placentation with future pregnancy, and reduced neonatal respiratory morbidity) with the potential harms (such as uterine rupture, which occurs in approximately one of 200 planned VBACs, based on the overall rate in Ontario from FYs 2014/15–2022/23).
There is notable variation in the rates of planned VBAC across regions in Ontario. In areas that cannot offer timely access to Caesarean birth, choices for planned VBAC may be more limited. Decisions may also be influenced by social, financial, or cultural factors.
The Provincial Council for Maternal and Child Health and Ontario Health collaborated on the development of this quality standard.
The scope of this quality standard extends from postpartum counselling after a Caesarean birth through antenatal and intrapartum care during the next pregnancy and birth. The guidance provided in this quality standard on pregnancy care focuses on people with a previous Caesarean birth who are pregnant with one baby that is head-down and at full term (> 37 weeks), who are receiving pregnancy care from any type of clinician. People with more than one previous Caesarean birth are included in the scope; however, research evidence is limited for this population. Careful individualized assessment and clinical judgement as part of shared decision-making are essential in this situation.
Quality Standard in Brief
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Quality Statement 1: Access to Vaginal Birth After Caesarean
People who have had a Caesarean birth before can plan a vaginal birth for their next birth, as long as there is no medical reason not to have one.
Quality Statement 2: Discussion After Caesarean Birth
After a Caesarean birth, people have a discussion with their physician or midwife and receive written information about the reasons for their Caesarean birth and their options for future births.
Quality Statement 3: Shared Decision-Making
Pregnant people who have had a previous Caesarean birth participate in shared decision-making with their physician or midwife. The discussion and planned mode of birth are documented in the perinatal record.
Quality Statement 4: Previous Vaginal Birth
Pregnant people who have had both a previous Caesarean birth and a previous vaginal birth are informed that they have a high likelihood of successful vaginal birth if no contraindication is present.
Quality Statement 5: Operative Reports and Incision Type
Physicians and midwives obtain an operative report from any previous Caesarean births whenever possible. Pregnant people who have had a previous Caesarean birth with an unknown type of uterine incision have an individualized assessment by their physician or midwife to determine the likelihood of a low transverse incision.
Quality Statement 6: Timely Access to Caesarean Birth
Pregnant people planning a vaginal birth after Caesarean are aware of the resources available and not available at their planned place of birth, including physician, midwifery, nursing, anesthesiology, and neonatal care, and the ability to provide timely access to Caesarean birth.
Quality Statement 7: Unplanned Labour
Pregnant people planning an elective repeat Caesarean section should have a documented discussion with their physician or midwife about the feasibility of vaginal birth after Caesarean if they go into unplanned labour. This discussion should take place during antenatal care and again if the person arrives at the hospital in labour.
Quality Statement 8: Induction and Augmentation of Labour
Pregnant people who have had a previous Caesarean birth are offered induction and/or oxytocin augmentation of labour when medically indicated, and are informed by their physician or midwife about the potential benefits and harms associated with the method proposed. Discussion about this should begin in the antenatal period.
Quality Statement 9: Signs and Symptoms of Uterine Rupture
During active labour, pregnant people who have had a previous Caesarean birth are closely monitored for signs or symptoms of uterine rupture.
Supporting Documents
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Patient guide for this quality standard
Know what to ask for in your care
Placemat for this quality standard
A quick-reference resource for clinicians that summarizes the quality standard and includes links to helpful resources and tools
Quality improvement tools and resources for health care professionals, including an action plan template
Supplementary information to support the data collection and measurement process
Additional Resources
If you would like to receive these resources, please send us a message using our contact form:
- Case for improvement (slide deck)
Share why this standard was created and the data behind it, to get the support you need to put it into practice - Technical specifications
See the technical specifications for the indicators within the quality standard - Tools to support patient care
- Summary of the public feedback we received
- Case for improvement (slide deck)
Last Updated: February 24, 2026
