Vaginal Birth After C-Section (VBAC) in India: Is It Safe and Who Qualifies?

If you have given birth to your baby through cesarean section previously and you become pregnant again, you could be wondering if you can go for a normal delivery. The answer is yes—for many women, VBAC delivery in India is a safe and achievable option. 

VBAC, which is short for Vaginal Birth After Cesarean, refers to the attempt at a regular delivery when a woman has had a C-section previously. With rising cesarean rates across India, more women are exploring this possibility, and medical guidelines now support VBAC for appropriate candidates.​

VBAC refers to delivering your baby vaginally after having had at least one cesarean delivery in the past. When you attempt this, doctors call it TOLAC—Trial of Labor After Cesarean. If the trial is successful and you deliver vaginally, that's when it becomes a VBAC.​

Many Indian women are now choosing to explore normal delivery after a C-section for their subsequent pregnancies. The choices are different for everyone: some to avoid the recovery time of a surgical delivery, some to be able to deliver naturally, and some to minimize risks that come with multiple surgeries.​​​

The medical community's view on VBAC has evolved significantly.  International guidelines set by RCOG and ACOG, and the Indian medical associations, have now recognized that the planned VBA is a safe option for most women, provided the proper criteria are met.​

This is probably your biggest question, and it deserves an honest answer. Yes, VBAC delivery in India is safe for women who meet the eligibility criteria and deliver in a well-equipped facility with an experienced medical team.​

Medical studies across several colleges in India have established that a lot of women actually deliver vaginally after their cesarean procedures. One such study is from Sitaram Bhartia Hospital in Delhi, which found that with proper institution and following protocols, the success rate could go as high as 90% with minimal complications.​

However, safety depends on several important factors. You need to be carefully evaluated to ensure you're a good candidate. The hospital must have facilities for an emergency C-section if necessary, and you would also need monitoring during labor.

The primary safety concern with VBAC is uterine rupture—when the old cesarean scar on your uterus tears during labor. While this sounds frightening, it's actually quite rare, occurring in less than one to two percent of VBAC attempts. When proper patient selection and monitoring are in place, most cases are detected early and managed successfully.​

Not every woman who has had a cesarean can attempt VBAC. Your safety and your baby's safety come first. Here's what doctors look for when deciding if you're a good candidate for normal delivery after a C-section.​

You had only one previous cesarean with a horizontal incision on the lower part of your uterus. It's been at least 18 to 24 months since your last cesarean, giving your uterus adequate time to heal. Your baby is in a head-down position, and your current pregnancy is progressing normally without complications like placenta previa. The reason for your previous cesarean was something specific to that pregnancy—like your baby being in breech position—rather than an ongoing issue. You've never had a uterine rupture before.​

Your previous cesarean had a vertical incision on the upper part of the uterus, as these scars carry a much higher rupture risk. You’ve had multiple previous cesareans, although some experienced physicians may consider a VBAC following two cesareans with proper counsel. You have placenta previa or other complications in your pregnancy, or your baby is breech or turned sideways.​

The most important step is getting a thorough evaluation from your obstetrician. They can assess you based on your past surgery records, as well as an ultrasound check of your scar, to determine individual risk factors

Several factors can increase or decrease your chances of successfully achieving normal delivery after a C-section.​

What increases your chances: If you've had a successful vaginal delivery before—either before or after your cesarean—your chances are significantly higher. If you go into labor spontaneously rather than needing induction, your success rate improves. A favorable cervix when labor begins, being at a healthy weight, and having a previous cesarean for a non-recurring reason like breech position all improve outcomes.​

What may reduce your chances: Needing labor induction can lower success rates. Having a higher body mass index, a large baby, or a previous cesarean due to labor not progressing may affect the outcome.​

The uterine rupture is one complication associated with VBAC. This happens when the old cesarean scar tears during labor. In India, studies show it occurs in less than two percent of VBAC attempts.​

What increases the risk? Using strong medications to induce or speed up labor, attempting VBAC when you're not a suitable candidate, and going into labor without proper monitoring in an unequipped facility.​

Warning signs include severe abdominal pain that doesn't go away between contractions, abnormal changes in your baby's heart rate on the monitor, and vaginal bleeding. This explains why continuous fetal monitoring during labor is necessary; it ensures that the baby’s complications, if any, are identified early.

Various studies conducted in hospitals across India indicate that the chances for VBAC are usually between 47 percent and 78 percent, depending on the hospital, as well as the group of women selected for VBAC. 

A major clinical study conducted in 30 medical colleges in India revealed that more than 60 percent of women who underwent VBAC were successful in their endeavor. Even higher chances for VBAC have been reported by certain centers, up to 90 percent

If you decide to pursue normal delivery after a C-section, proper preparation increases your chances of success.​

Medical preparation is essential. You should set up an appointment with an obstetrician experienced with VBAC. Obtain a copy of all the records related to your past cesarean section, including the kind of incision made. Your obstetrician may request an ultrasound to determine how thick the scar tissue of the uterus is.

Choose the right facility. Attempt VBAC only at a facility prepared for emergency caesarean sections. You can be certain the hospital has the necessary equipment for emergency caesarean sections at any time of the day or night. The facility will be prepared with anesthesia services and a blood bank.

Physical preparation matters too. Maintain a healthy weight throughout your pregnancy. Exercise regularly by walking and doing prenatal exercises that your doctor approves. Also, practice your pelvic floor exercises to strengthen your pelvic muscles that will be useful during the time of child birth.​

Don't neglect emotional preparation. Educate yourself thoroughly about the VBAC process. If you had a traumatic experience with your previous cesarean, consider talking to a counselor. 

When you go into labor, the hospital will provide continuous electronic fetal monitoring to watch your baby's heart rate patterns carefully. Your medical team will regularly check your cervix to ensure labor is progressing normally. The operating theater will be kept ready for immediate cesarean if needed.​

Your medical team maintains open communication with you about how things are progressing. If at any time your caregivers feel there is a safety concern for you or your baby, they will suggest moving to cesarean delivery. Remember, flexibility is the word. A birth plan is a guide, not a promise.

VBAC delivery in India is a safe and achievable option for many women with previous cesareans. Success depends upon careful selection of patients, proper facility preparedness, experienced medical teams, and continuous monitoring throughout labor.

First of all, if you want to try to go vaginal after being sectioned before, you have to sit down with your obstetrician and talk about your options. Get an assessment to see if you are a good candidate. Pick a hospital that is equipped to deal with VBAC deliveries. Your mind and body will have to be prepared for any eventuality. VBAC or repeat section – you will end up with the same joy – holding your baby! Vaginal delivery or section – you're making the best out of your particular situation.

The ParentZ website provides you with the means to track your pregnancy, as well as professional advice from experienced individuals to help you through this process. Trust your body, trust your medical team, and trust yourself to make the right choice. Visit https://www.theparentz.com/ or download the ParentZ App to get personalized support at every stage of pregnancy and parenthood.

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