Spontaneous vaginal birth after multiple previous caesarean sections: A case report and literature review

Background: Vaginal birth after caesarean section (VBAC) is increasingly recognized as a safe and effective option for women with a history of Caesarean deliveries. However, limited attention has been given to feasibility and safety of VBAC after multiple caesarean sections. Case presentation: A 36-year-old woman with a history of four previous Caesarean sections presented in our centre in third stage of labour. Despite counseling for elective Caesarean section, she had a spontaneous vaginal delivery of a live 2.6 kg female neonate in a vehicle en route to the hospital. On arrival, she was stable but had lost about 500ml of blood. Immediate interventions included active management of third stage of labour and assessment for perineal injuries, with subsequent monitoring and blood transfusion. She had a normal postpartum recovery, was discharged after four days, and had a reassuring 6-week post-natal visit, with a referral to family planning. Conclusion: This case underscores the potential success and safety of vaginal birth after multiple (three or more) Caesarean sections, challenging the notion that a history of repeated C-sections precludes this option. Vaginal birth after CS (VBAC), initially restricted to one previous CS, is now considered in selected cases with two prior abdominal deliveries. However, the acceptance of VBAC after three or more CS remains limited despite available evidences indicating comparable success rates and maternal risks for VBAC after multiple CS when compared to VBAC after one prior CS or elective repeat CS.