Widespread increase in the number of caesarean section (CS) noticed in the past thirty years has been a reason of major concern and has necessitated an in-depth study in this regard. Prior to 1970, the saying ‘Once a caesarean, always a caesarean’ dictated most obstetric practices. Later on due to the rising cases of CS, propositions were made that natural vaginal birth subsequent to CS or known as Vaginal Birth After Caesarean (VBAC) could assist in decreasing the rate of CS. It was noted that VBAC was proven to be safe and effective in apposite clinical situation and appropriately selected group of women.

It has been observed that all post-caesarean pregnancies do not need repeat CS and most of them could have unfussy vaginal delivery. A trial of vaginal birth subsequent to a past CS known as VBAC is deemed safe than a routine repeat CS. VBAC has many distinctive advantages than a repeat CS as the operative risks are totally purged, the post-operative recuperative hospital stay is significantly shorter and the costs involved are much lesser. Yet, there are numerous factors that raise the likelihood of an unsuccessful trial that could in turn lead to raised maternal and perinatal morbidity and death levels. Hence in this matter, the trial of vaginal delivery in women with post caesarean pregnancy continues to be controversial with continual critical auditing of the trends is crucial.

The study on an observation that spanned over two years concluded that women with past singular lower section CS (LSCS) needed special management in both antenatal care and during labor. The decision to go in for either a trial for labor or the elective repeat LSCS is wholly a personal choice that should be based on wary choice and meticulous counselling. The maternal attributes and obstetric past could provide a rough approximate.

Factors that are believed to unfavourably influence the possibility of successful VBAC are considered to be those cases with labor induction and augmentation, maternal overweight or obesity, gestational age more than forty weeks, birth weight being more than 4000 gm and inter-delivery interval being less than nineteen months. A past of successful VBAC raises the chances of success in futuristic endeavours. The risk of uterine rupturing is greater during induced labor than in unprompted labor with trial, with inducing and augmenting by oxytocin considered safe in particular cases, though the use of prostaglandins for inducing labor needs greater caution. Neither repeat CS delivery nor trial of labor is risk free.

Thus, with appropriate selection, timing and minute observation by adept staff, the trial for vaginal delivery eradicates the need for greater cases of repetitive caesarean operations.

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