Skip to main content

Evidence to Improve Care

Vaginal Birth After Caesarean (VBAC)

Care for People Who Have Had a Caesarean Birth and Are Planning Their Next Birth

Click below to see a list of brief quality statements and scroll down for more information.​​

Quality standards are sets of concise statements designed to help health care professionals easily and quickly know what care to provide, based on the best evidence. ​

See below for the quality statements and click for more detail.​

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 is 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.

Health Quality Ontario and the Provincial Council for Maternal and Child Health thank the following individuals for their generous voluntary contributions of time and expertise to help create this quality standard:

Manavi Handa (Co-Chair)
Registered Midwife, Associate Professor
Ryerson University

Modupe Tunde-Byass (Co-Chair)
Obstetrician and Gynaecologist
North York General Hospital

Nicolette Caccia
Obstetrician and Gynaecologist
Humber River Hospital

Pilar Chapman
Registered Midwife
West Lincoln Memorial Hospital

Shasta Cividino
Clinical Manager, Birthing Services
Trillium Health Partners

Tracie Delisle
Nurse Clinician
Health Sciences North

Perle Feldman
Associate Professor, Family Medicine
McGill University

Joanne Mackenzie
Senior Director, Women’s & Infants’ Health
Sinai Health System

Cathy Ottenhof
Better Outcomes Registry and Network (BORN) Coordinator
BORN Ontario

Catherine Pepevnak
Lived Experience Advisor

Steve Sears
Family Physician
Temiskaming Hospital & Temiskaming Shores

Patricia Smith
Deputy Chief Obstetrics
Division Head, Maternal Fetal Medicine
McMaster University Medical Centre

Health Quality Ontario also thanks the PCMCH Maternal-Newborn Advisory Committee, chaired by Gareth Seaward and Siobhan Chisholm, for providing feedback on this quality standard.

Let’s make our health system healthier

Join Our Patient, Family and Public Advisors Program

Patients, families and the public are central to improving health quality.

Man smiling

Sign up for our newsletter

Are you passionate about quality health care for all Ontarians? Stay in-the-know about our newest programs, reports and news.

Health Quality Connect - Health Quality Ontario's newsletter - on an iPad and a cell phone