Vaginal Birth After Cesarean: Maternal and Fetal Outcomes in a Multicenter Study

Background: Vaginal birth after cesarean (VBAC) is widely regarded as a key approach to lowering unnecessary repeat cesarean rates while supporting safer, more cost-effective maternal care. Beyond aligning with a woman’s preference for vaginal delivery, VBAC offers significant health benefits — it can lower the risk of maternal complications, reduce the likelihood of problems in subsequent pregnancies, and contribute to an overall decline in population-level cesarean delivery rates. This study aimed to evaluate VBAC outcomes in high-fertility regions of Türkiye. Methods: This retrospective, multicenter observational study was conducted in four secondary-level hospitals located in high-fertility regions of Türkiye, including women with a history of one prior low-transverse cesarean section who attempted vaginal birth between January 2020 and May 2025. Maternal demographics, obstetric history, and delivery outcomes were compared between successful and unsuccessful VBAC attempts. Results: 342 participants of the 314 (91.8%) achieved successful VBAC. Higher Bishop scores and gestational age predicted success. Unsuccessful VBAC was associated with increased maternal morbidity, including uterine rupture and and blood transfusion requirements. Additionally, neonatal outcomes such as Apgar scores were less favorable in the unsuccessful VBAC group. Conclusions: VBAC success rates are high in selected patients, but careful candidate selection is essential to minimize complications. Our findings indicate that VBAC can achieve high success rates in appropriately selected patients, even in high-fertility regions.