VBAC: Can Hypnobirthing Help You Achieve a Vaginal Birth After Caesarean?
If you are planning a vaginal birth after caesarean, commonly referred to as a VBAC, then this blog is written for you.
Let’s start with specifics... Not with a list of risks. Not with a disclaimer. But with something that I believe you deserve to hear clearly and that not enough women are told:
The evidence in support of VBAC, for the right woman in the right circumstances, is strong. And the risks that are most commonly cited, without context, numbers or distinction between absolute and relative risk, are frequently presented in a way that does not serve you well.
I'm Melanie, a birth doula and hypnobirthing teacher who has supported VBAC births and who has sat with women who were told, in vague and alarming terms, that their VBAC was 'risky' by care providers and family members without ever being told what that risk actually was. This piece is about changing that.
Absolute risk vs relative risk — the most important distinction you will learn..
When a clinician tells you that attempting a VBAC increases your risk of uterine rupture, they are telling you something true. What they are often not telling you is how small that risk is in real numbers and clearly that distinction matters enormously.
Relative risk tells you how much bigger one risk is compared to another. Absolute risk tells you the actual likelihood of something happening to you. These two numbers can sound very different and the difference between them is the difference between an informed decision and a frightened one.
So, let’s look at the evidence:
What the evidence actually says about VBAC
Success rates
According to the Royal College of Obstetricians and Gynaecologists (RCOG) Green-top Guideline on Birth After Previous Caesarean, the overall success rate for planned VBAC is 72% to 75% for women with no previous vaginal birth. For women who have had a previous vaginal birth as well as a caesarean, that rises to 85% to 91%.
This means that the majority of women who plan a VBAC will achieve one.
Uterine rupture — the risk in real numbers
The risk most commonly cited in conversations about VBAC is uterine rupture, the original scar giving way and it is a serious complication when it occurs.
For women with one previous low transverse caesarean scar, the absolute risk of uterine rupture during a planned VBAC is approximately 0.5% — that is around 5 in every 1,000 women. Some studies report figures between 0.3 and 0.7% depending on population and methodology. So this means a 99.5% chance of not having a uterine rupture.
For context: the risk of uterine rupture in a woman having a planned repeat caesarean is approximately 0.02% which is around 2 in every 10,000.
So yes, the relative risk is higher with VBAC. But the absolute risk of uterine rupture during a planned VBAC, for a woman with a single low transverse scar, remains very low. That is the number you need to know. That is the number you are entitled to be given by your care providers.
Important distinction: These figures apply to women with a single previous low transverse caesarean scar. The risk profile changes if you have had two or more caesareans, if your previous scar was classical (vertical), or if labour is induced. Clearly, always discuss your individual circumstances with your consultant.
The evidence on induction and VBAC
The evidence suggests that induction of labour in the context of VBAC increases the risk of uterine rupture, particularly when prostaglandins are used. Mechanical methods of induction (Cooks catheter, artificial rupture of membranes) carry a lower associated risk than chemical methods. If induction is being discussed in the context of your VBAC, this is an important area to explore in detail with your care team — and to apply your BRAIN framework to.
To quote the Green-top Guideline on induction for VBAC birth:
‘Women should be informed of the two- to three-fold increased risk of uterine rupture and around 1.5-fold increased risk of caesarean delivery in induced and/or augmented labour compared with spontaneous VBAC labour.’
‘Clinicians should be aware that induction of labour using mechanical methods (amniotomy or Foley catheter) is associated with a lower risk of scar rupture compared with induction using prostaglandins.’
Perinatal outcomes
Intrapartum fetal death associated with VBAC (the death of a baby that occurs after the onset of labor but before the baby is born) is rare. The RCOG guidelines note a rate of approximately 1 in 1,000 for planned VBAC — comparable to the risk for women in their first pregnancy, and higher than the rate for planned repeat caesarean which is approximately 1 in 10,000.
These are not figures to be minimised. Clearly if you are the 1 in 10,000 then that is 100% for you. However, these are figures to be understood clearly, in context, as part of an informed conversation with your care team — not delivered as a reason to abandon your VBAC plans without further discussion.
Where to go for evidence-based VBAC information
Three resources I recommend wholeheartedly for women researching VBAC:
Dr Sara Wickham (sarawickham.com) — an internationally respected midwife and author who writes with clarity and rigour about the evidence behind birth decisions, including VBAC, induction and the framing of risk.
Evidence Based Birth (evidencebasedbirth.com) - founded by Dr Rebecca Dekker, EBB focuses on empowering women to make informed decisions by analyzing the top three pillars of care: the best available research, clinical expertise, and individual patient preferences/values.
Dr Rachel Reed (rachelreed.website) — a midwife, researcher and author whose work on birth physiology and women's rights in childbirth is essential reading for anyone navigating a VBAC decision.
All write accessibly for women as well as for clinicians and will help you understand not just the numbers, but the questions worth asking.
Knowledge-based learning the foundation of your VBAC preparation
Here is what I tell every woman I support through a VBAC journey:
Dive deeply into knowledge-based learning with VBAC so that appropriate plans can be put in place for you as an individual. This means exploring and understanding the accurate evidence. Know the difference between absolute and relative risk. And then from that foundation of knowledge, make the decision that is right for you.
A VBAC is not a one-size-fits-all. Your history, your scar type, your interval between your children, your care provider, your birth setting, your previous birth experiences, all of these shape your individual risk and likelihood of success. The decision you make should be based on your circumstances, not on generalised opinion, preferences or fears. Trust your intuition and trust yourself.
So, how does hypnobirthing support your VBAC?
Hypnobirthing is not a guarantee of any particular birth outcome. Instead it is a powerful framework for approaching your VBAC with knowledge, calm and agency, rather than with the fear and tension that can work against you.
For VBAC specifically, hypnobirthing offers:
A deep understanding of the fear-tension-pain cycle and how to interrupt it, which is particularly important in VBAC where fear of uterine rupture can create exactly the tension that makes labour harder.
Breathing techniques that support calm and help you stay in your parasympathetic nervous system throughout labour.
A framework for decision-making — the BRAIN tool or Four Quadrant Decision Making — that helps you navigate any clinical decision in labour with clarity rather than panic.
Birth partner training so that the person with you knows how to support you, advocate for you, and hold the space calmly throughout.
Preparation for multiple scenarios — your VBAC plan A, your plan B, and your contingencies — so that you are never making decisions in the dark.
A profound trust in yourself, your baby and your decision making capabilities as well as deep and powerful resilience.
The women I have supported through VBAC, who have done this preparation arrive in the birth room differently. They know their evidence. They know their rights. They know their birth partner is prepared. And that knowledge forms the road map that will guide them through their birth experience, however they ultimately choose to birth their baby.
Planning a VBAC? Here's where to start.
The Better Birth Stories Online Hypnobirthing Course covers all birth types — including VBAC, caesarean birth and induction — and includes the decision-making tools, birth partner training and breathing techniques that support VBAC preparation. 94 lessons, 12 professional MP3s, £39, 30-day guarantee.
→ Explore the Online Hypnobirthing Course