FIGO good practice recommendations for vaginal birth after cesarean section

Abstract

The rising global rate of cesarean section (CS) has prompted renewed focus on vaginal birth after cesarean (VBAC) as a safe and effective alternative to repeat CS in properly selected women. The FIGO good practice recommendations provide evidence-based recommendations to guide VBAC care. Success rates for VBAC range from 60% to 80%, with the highest likelihood in women with prior vaginal birth, non-recurrent CS indications, interbirth intervals ≥18 months, BMI <30 kg/m2, and spontaneous labor onset. While uterine rupture is the primary concern, its risk remains low at approximately 0.3%–0.7% for women with one prior low transverse CS. Comparisons show that VBAC generally results in similar or better maternal and neonatal outcomes than planned repeat CS, including lower maternal mortality, fewer infections, and shorter hospital stays. This article emphasizes appropriate patient counseling, facility readiness for emergency CS, and continuous fetal monitoring during labor. With proper implementation, VBAC offers a valuable strategy to reduce unnecessary repeat surgeries, improve outcomes, and support informed maternal choice.