Vaginal birth after cesarean (VBAC) is no longer an exception. It doesn’t raise questions either. Nowadays, VBAC is considered a viable and safe option (associated with a 60% to 80% success rate) for many women. I believe that VBAC is a birth option that needs to be offered more in Greece. It provides many advantages, such as no surgery on the belly and lower risk of serious blood loss and infections. Also, it is known that many women trying for a VBAC had positive experiences during pregnancy and childbirth.
What is VBAC, and when and how should it be performed?
VBAC, which stands for Vaginal Birth After Cesarean, is considered a completely safe option after a previous birth by cesarean section in England, where I studied. Critics of VBAC often refer back to 1916, when Edwin Cragin stated in a public speech, “Once a cesarean, always a cesarean.” Things have changed. In Canada and America, doctors and scientific personnel argue that it should be included in state medical care measures so that all women who have already had a cesarean section can choose whether they want to give birth to their next child by VBAC. Many medical studies support the idea that an additional cesarean section is much more dangerous than a VBAC for the mother and the newborn. I repeat, a C-section is still surgery, and as such, it should only be considered an emergency medical procedure, not an elective one.
Questions and inquiries about VBAC
Many women ask how long they should wait after a cesarean delivery before becoming pregnant again and giving birth via VBAC.
The recommended gap should be at least 18 to 24 months.
How should a VBAC be performed?
A necessary condition for ensuring a successful VBAC is the correct selection of an experienced doctor in the fields of fetal medicine and high-risk pregnancy, supported by a specialized medical team (providing obstetric, hematological, and neonatal support). Additionally, more intensive monitoring of both the mother and the fetus is required throughout the pregnancy to achieve this unprecedented experience of natural childbirth, which only nature and the female body could have foreseen. The strength and affirmation of a woman after all the effort she puts in, the bonding with her partner who is also present at the moment of birth and cuts the umbilical cord, and the skin-to-skin contact with her baby whom she immediately takes into her arms, is truly overwhelming.
What are the risks of attempting a VBAC?
The risk of uterine rupture, meaning the old incision opening due to a previous cesarean section, is actually minimal, and in any case, the likelihood of this happening is around 0.5%, something an experienced maternal-fetal medicine specialist with a team of trained colleagues can ensure. The doctor who will be overseeing your VBAC needs to review your medical records to ensure there is no history of uterine rupture in a previous delivery, that you have had no more than two previous cesarean sections, and to determine what type of incision you had from your previous cesarean. If the incision is not T-shaped but lower in the uterus, near the cervix, VBAC is safer. Besides, most women today have the incision low, in the lower segment of the uterus. VBAC has fewer chances of success when the baby’s birth weight is predicted to be large (over 4 kilograms) and the mother’s age is over 40 years.
VBAC, step by step
Choosing an MFM specialist and a trusted team to support them so that the couple, and especially the expectant mother, will faithfully follow their instructions (for example, undergoing all the ultrasound and other check-ups, not gaining unnecessary weight, exercising, etc.), will help her gradually build this feeling of security and safety that she so desperately needs, and with the guidance of her doctor and the support of her midwife, experience an unforgettable birth.
What are the advantages of VBAC compared to a C-section?
For the mother, it’s a deep satisfaction and an even deeper physical and emotional transformation through a completely natural process that spares her an unnecessary surgery. Skin-to-skin contact creates an intense bond between mother and newborn child. Another difference is that almost immediately after this traumatic event, they get out of bed, walk, and leave the hospital faster without any mandatory recovery period.
However, there are also advantages for the newborn. Passing through the mother’s birth canal strengthens the baby’s respiratory and immune systems, reduces the future likelihood of childhood asthma and obesity, strengthens the bond with the parents, and facilitates immediate breastfeeding.
Conversely, another cesarean section carries a higher risk of adhesions in the pregnant woman’s abdomen, potentially leading to bleeding during that or the next delivery, and an increase in neonatal morbidity with a high probability of respiratory distress in the infant.
How big is the fear of childbirth, and how justified is it?
I know from my patients who had VBAC after a C-section that even their close circle of friends and family were initially against their decision. Perhaps because when something is considered standard practice, another process surprises us, disrupts the status quo, awakens us to overprotectiveness, and sometimes causes fear of our loved ones. But I’ve never seen anyone, and especially no new mother, who regretted doing it. On the contrary, I would say that their reactions to giving birth naturally, with a VBAC, painlessly, and with such positive spirits are so intense and profound that they impress even me, even though I’ve been with them throughout the entire pregnancy and childbirth process from the beginning.
And how widespread is the practice of cesarean sections in our country?
As a professor of Obstetrics and Genetics at the University of West Attica and a collaborator with many public gynecology clinics throughout Greece, I know that a percentage of births are performed either by scheduled or emergency cesarean section. In our country, this percentage of cesarean sections exceeds 52%, while according to the World Health Organization (WHO), it should be around 15%.
Conclusion
Every woman has the right to bring her child into the world as she wishes, and every birth (regardless of the method used) is an achievement. Furthermore, in many cases, a C-section proves to be not only life-saving but also the only solution; let’s not forget that. A woman chooses the VBAC method, not just because she avoids surgery, but because she chooses what she wants and achieves it. And this moment is so special that it cannot be explained in words, nor can the feeling be conveyed.
Learn more about natural childbirth after cesarean section in the following video:
Women’s experiences who chose VBAC
Every woman experiences her own unique journey to childbirth. Below, we share the experience of a mother who chose to give birth vaginally after a previous cesarean section (VBAC), as she described it herself.
My VBAC Experience: When My Second Birth Healed the First
During my second pregnancy, I had one deep desire: to give birth vaginally after a previous cesarean section (VBAC).
It was not simply a preference for vaginal birth. It was a need to come to terms with the experience of my first delivery, which ended in a cesarean section and left me with intense feelings of disappointment and incompleteness. Although today I know that a cesarean section is a valuable and often life-saving medical procedure, at the time I felt that I had lost something important.
When I became pregnant for the second time, I knew that I wanted to try for a VBAC. Not to prove anything to anyone, but because I felt I owed it to myself.
At this point, I would like to talk about two people without whom I do not know whether I would have made it this far.
First of all, Mr. Nikolaidis.
In a country where many women still hear that VBAC is difficult or almost impossible, he is one of the doctors who has dedicated himself to supporting and promoting it. From the very beginning, I felt that I was in the care of someone with deep knowledge, extensive experience, and solid scientific training. Every question I had was answered honestly and with evidence, without false promises, but with something much more important: trust. Trust in his knowledge, in the chances of success of my attempt, and in the assurance that, if any difficulty arose, I would be in the best possible hands.
Equally important was the presence of my midwife, Mrs. Lambrini.
For me, she was much more than a midwife; she was like a second mother throughout this journey. Through childbirth preparation classes, our conversations, and the knowledge she shared with me, she helped me understand my body and become familiar with the process of vaginal birth.
She did not just give me information. She gave me faith: faith in my body, in my baby, and in my own strength. And when the big day arrived, she was there, calm and steady, supporting me every step of the way. As I have told her myself, she has a unique gift as a person, something deeply spiritual, because she truly believes in what she does and genuinely loves it.
VBAC is not only a medical procedure; it is also a deeply psychological journey. If I am sharing a successful VBAC experience today, it is because I had people by my side who offered me knowledge, safety, support, and confidence. And for that, I will always be grateful to them.
My VBAC birth was a tremendous success. For the first time, I felt my body doing exactly what it was designed to do. I felt strength. I felt trust. I felt that I was working together with my baby in a shared effort that brought us together in the most natural way.
As a ballet and Pilates instructor, I have learned to deeply respect the human body. I understand its capabilities, but also the cost of every injury and every surgical procedure.
A cesarean section is a major operation. It is a procedure that requires time, recovery, and significant physical rehabilitation. That is why, for me, the possibility of a vaginal birth was extremely important. I wanted to regain my strength quickly. I wanted to be able to lift my baby without pain. I wanted to be able to hug my older child without limitations. Above all, I wanted to be the best version of myself as a mother.
And the difference I experienced after my VBAC was truly remarkable. The very next day, I was able to move almost normally. Within a few days, I felt strong again. My endurance returned quickly. My body responded impressively.
But what mattered most was not my body.
It was motherhood.
After my first birth, the pain from the cesarean section and the difficult recovery prevented me from being the mother I wanted to be during my baby’s first month.
After my VBAC, I was present from the very first moment. I had energy. I had independence. I was able to care for my baby without simultaneously struggling with my own postoperative pain.
And that is beyond comparison.
Today, looking back, I do not feel that VBAC made me a better mother. However, it helped me feel stronger, more complete, and more at peace with my story.
That is why I firmly believe that women deserve proper information about VBAC. They deserve to know that, in many cases, vaginal birth after cesarean is a safe and scientifically supported option. Of course, it is essential to have the right people by your side. Women deserve access to healthcare professionals who will listen to them, guide them, and support them.
And above all, they deserve to have choices.
My message today is not that every woman should have a VBAC. My message is that every woman should have the right to try when she is an appropriate candidate and when she wishes to do so.
Because sometimes a second birth does not only bring a baby into the world. It also brings a mother closer to herself.
And for me, that is exactly what my VBAC was.
A second beginning.
A deeply healing experience.
A reminder that our bodies are far stronger than we believe, and that when the right people are beside us, it is worth giving ourselves the opportunity to try.
When I first told people I wanted to have a VBAC, I expected praise and support. Instead I was met with hesitancy, negativity and incorrect advice. Nikos, my husband, knew how important it was for me. We were going to find the people to make it happen for us. My good friend Elena introduced me to Dr. Nikolaidis and midwife of 45+ years Lamprini Palikara. They told me I had a healthy pregnancy and was a great candidate for a VBAC. I was more than ready and so excited.
As a woman in Greece, being able to deliver my baby naturally, against so many odds and a system that prioritizes cesarean sections, was a huge accomplishment for me. I don’t think a single day went by where someone did not assume or tell me I was going to have a c-section because my first baby was. I went into this pregnancy and ultimately the hospital knowing I wanted a natural delivery more than anything. I knew what my body was made to do. I knew what it was capable of.
Actually experiencing it was the most empowering journey I have ever been on. I had my husband and my midwife Lamprini by my side every second. Some pain, some pressure. But nothing I couldn’t handle. Nothing WOMEN can not handle. A few hours of contractions, some controlled pushes and my baby was born. I completely surrendered. It was beautiful. It was the essence of being a woman. A mother. It was better than anything I could have ever dreamed of. It healed a piece of my soul that was missing when I did my first birth by c-section.
Giving birth naturally wasn’t scary, or excruciatingly painful or any of those things they want you to think. It was nature taking its course, the completion of a healthy pregnancy cycle. The last piece. It was a happy experience. It was powerful. It was meaningful. I enjoyed every moment, even through the challenges. I was happy.
I had a husband who believed in me. A friend who believed in me. A doctor and a midwife who believed in me. And most of all, I never stopped believing in myself and knowing I could do it.
I owe my entire birth team a huge thank you from the bottom of my heart. I am holding my healthy beautiful baby boy in my arms as I write this. I am proud and thankful that I was able to give him the birth he deserved. I encourage every woman to open their eyes to the beauty and wonder of natural delivery. It’s something that stays with you forever. It is a gift. We were made for this. Thank you so much again.
