VBA2C in Ireland: What the Evidence Actually Says and How to Prepare

This information is coming from a Doula & Antenatal Educator who has supported families for 15+ years, but also from a mother who achieved an unmedicated VBAC herself. I know what it takes to make this happen so here are my top tips for you x

If you are planning a vaginal birth after two caesarean sections in Ireland, this is the post I wish more women had access to. Because the picture the evidence paints is very different from what many women are being told in clinic rooms across the country.

Let's start with the numbers that don't get talked about enough.

What the statistics actually show

In 2023, 41% of first-time mothers in Ireland gave birth by caesarean section, according to the HSE's own Maternity Indicator System. That figure has been rising steadily for a decade. In five Irish maternity units, the caesarean rate for first-time mothers exceeded 50%. In a further six units it was between 40% and 49%. (HSE Maternity Indicator System 2023 / AIMS Ireland analysis of HSE maternity safety statements 2023)

Now look at the VBA2C numbers.

A 2024 systematic review and meta-analysis published in the Journal of Obstetrics, Gynecology and Cancer Research reported a mean VBA2C success rate of 72% across more than 3,000 cases. Ireland's own national VBAC guidelines state that overall success rates are in the region of 72 to 75%, rising to as high as 85 to 91% for women with a history of previous vaginal birth. One retrospective study reported a success rate of 92.8% in women with a prior vaginal delivery. (Salehi et al. 2024 / HSE National Clinical Practice Guideline on VBAC / De Leo et al. 2020)

In some Irish maternity units, a woman planning a VBA2C has a better statistical chance of vaginal birth than a first-time mother walking through the same door.

This is not about frightening first-time mothers or dismissing the complexity of birth. It is about making sure that women planning a VBA2C understand that the fear and resistance they sometimes meet in the system is not reflected in the evidence. The evidence is on their side.

Ireland's national VBAC guideline also states clearly that a successful VBAC carries the lowest morbidity of all birth options. Not a repeat caesarean. Not a trial of labour that ends in emergency surgery. A successful vaginal birth. (HSE National Clinical Practice Guideline on VBAC)

Why preparation matters so much

The research consistently shows that outcomes for VBA2C are significantly influenced by how well a woman is prepared, how supported she feels, and how informed her decision-making is throughout pregnancy. This is where the difference is made, long before labour begins.

Here is what the evidence, and my fifteen years of supporting families through birth, tells me actually helps.

Debrief your previous birth experiences

This is one of the most overlooked and most important pieces of preparation for a VBA2C. Unprocessed fear and trauma live in the body. They affect how labour unfolds, how we respond to pain, and how we make decisions under pressure. Working through previous births, whether with a birth debrief practitioner, a therapist, or a doula who understands trauma-informed care, is not a luxury. It is some of the most powerful preparation you can do.

If you had a difficult experience in your previous births, perhaps feeling unheard, unaware of what was happening, or like things were being done to you rather than with you, those experiences deserve to be acknowledged and processed before you walk into a labour ward again.

Get independent antenatal education

Not just the sessions your hospital offers. Independent antenatal education, from a provider who has no affiliation to a specific maternity unit and no agenda other than your informed decision-making, is a completely different experience. It covers your rights, your options, the evidence, and how to navigate the conversations you will have with your care team. It prepares you to ask questions, understand the answers, and make decisions that are genuinely yours.

Ireland has the highest rate of induction of labour for first-time mothers of any high-income country studied. (Cross-sectional study of 13 high-income countries, 2013; Irish figure rose to 43.6% by 2020) Independent education helps you understand what that means for you and your specific situation.

Hire a doula who understands VBAC and caesarean support

The evidence on this is unambiguous. The Cochrane Review on continuous labour support (Bohren et al. 2017), one of the most comprehensive reviews in maternity research covering over 15,000 women across multiple countries, found that continuous support in labour significantly reduces caesarean rates, increases the likelihood of spontaneous vaginal birth, shortens labour, and improves women's satisfaction with their birth experience.

For a VBA2C specifically, having someone in that room who knows the evidence, understands your history, knows your preferences inside out, and can hold the space calmly when things feel uncertain is one of the most practical and impactful decisions you can make. A good VBAC doula will also know your local maternity system, understand the culture of the unit you are birthing in, and be able to support you in having the conversations that matter before you ever go into labour.

Write clear, informed birth preferences

Not a wish list. Not a document that says "I would prefer" and then lists things in the hope that someone reads it. A clear, evidence-informed set of preferences that demonstrates you understand your options, know your rights, and have made considered decisions in partnership with your care provider.

Include your preference for spontaneous onset of labour wherever possible. Spontaneous labour is the single strongest predictor of successful VBAC, according to both the HSE national guideline and the RCOG Green-top Guideline No. 45. Include your entitlement to one-to-one midwifery care in labour, which is a formal recommendation in Ireland's national VBAC guideline, not a request. And include your preferences around monitoring, pain relief, positioning, and what you want to happen if things change.

Have honest, open conversations with your care provider

Early. Regularly. Ask what the unit's VBAC rate is. Ask what their VBA2C policy is. Ask what happens if you reach 41 weeks without spontaneous labour. Ask about their approach to continuous monitoring and mobility. If the answers make you uncomfortable or if you feel your preferences are being dismissed rather than discussed, you are allowed to seek a second opinion. You are allowed to change care providers. You are allowed to ask for a senior consultant review.

The research shows that care providers' recommendations are among the strongest influences on women's birth decisions. (Swiss study cited in HSE national VBAC guideline) You deserve a provider who is working with you, not around you.

Prepare your birth partner

An empowered, informed birth partner is part of your birth team. They cannot advocate for you if they do not know what to advocate for. They cannot hold the space if they are overwhelmed by fear or uncertainty. Prepare them alongside you. Bring them to your antenatal education. Talk through your birth preferences together. Make sure they know what matters most to you and why.

Know how to make informed decisions

The BRAIN framework is a simple tool for every conversation with your care provider throughout pregnancy and labour.

Benefits: what are the benefits of what is being suggested?

Risks: what are the risks?

Alternatives: what are the alternatives?

Intuition: what does your gut tell you?

Nothing: what happens if you wait or do nothing right now?

You are allowed to ask these questions. You are allowed to take time before agreeing to anything. You are allowed to say no. Informed consent is not a formality. It is a fundamental right.

Know your rights in labour

Ireland's national VBAC guideline states that women planning a VBAC are entitled to one-to-one midwifery care in labour, that the obstetric consultant on call should be made aware of your admission to the delivery suite, and that continuous electronic fetal monitoring should be commenced from the diagnosis of labour. These are formal clinical recommendations. Know them before you arrive.

A final word

I have been in hundreds of birth rooms over fifteen years. I have supported women through straightforward births and complicated ones, through VBACs and caesareans, through moments of profound joy and moments of real difficulty.

What I know without question is this: the women who go into a VBA2C feeling informed, supported, and connected to their own instincts have a fundamentally different experience, regardless of how their birth unfolds. Preparation is not about controlling the outcome. It is about knowing yourself, knowing your options, and trusting that whatever happens, you were fully present and fully informed.

You know your body and your baby better than anyone in that room.

Trust her.

Jen x

Join my Birth Doula training here and my Supporting VBAC & Caesarean Birth CPD day here

Sources

HSE National Clinical Practice Guideline on VBAC

HSE Maternity Indicator System 2023

AIMS Ireland analysis of HSE maternity safety statements 2023

Salehi M. et al. Vaginal Birth After Two Cesarean Sections (VBAC-2), Success Rate and Adverse Outcomes: Systematic Review and Meta-Analysis. Journal of Obstetrics, Gynecology and Cancer Research, 2024

De Leo R. et al. Vaginal Birth after Two Previous Cesarean Sections versus Elective Repeated Cesarean: A Retrospective Study. Journal of Perinatology, 2020

Bohren M.A. et al. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, 2017

RCOG Green-top Guideline No. 45: Birth After Previous Caesarean Birth

Cross-sectional study of induction rates in 13 high-income countries (Chalmers et al. 2016, cited in Irish maternity research)