Aim To compare clinical outcomes of two approaches to birth after primary caesarean; i) planning elective repeat caesarean section (ERCS) ii) planning to attempt vaginal birth after previous caesarean (VBAC), with outcomes of second and third pregnancies evaluated.

Methods The population of this retrospective cohort study was identified from the Aberdeen Maternity and Neonatal Databank. Those included were women and offspring of pregnancies following primary caesarean delivery between 1993 and 2007. Planned mode of delivery was ascertained using four recorded variables; gestation at delivery, induction of labour, actual mode of delivery and indication for emergency caesarean section.

Main Outcomes Mode of delivery, pre-eclampsia, antepartum haemorrhage, postpartum haemorrhage, bladder injury, scar rupture and hysterectomy in the women. Neonatal unit admission, hypoxic ischaemic encephalopathy and cerebral palsy in the offspring.

Results Of 2350 women identified, 1211 planned ERCS and 1139 planned to attempt VBAC. One in four women planning ERCS delivered by emergency caesarean section before their planned delivery date. Of those planning VBAC, 796 delivered vaginally. Women planning ERCS were less likely to experience pre-eclampsia {adjusted odds ratio (OR) 0.7 (95% confidence interval (CI) 0.6–0.9)}. antepartum haemorrhage {adjusted OR 0.7 (95% CI 0.5–0.9)} or postpartum haemorrhage {adjusted OR 0.5 (95% CI 0.4–0.7)} than those attempting VBAC. Neonatal unit admission was more likely if ERCS was planned {adjusted OR 1.3 (95% CI 1.1–1.6)}, but this was gestation-related.

Conclusion Delivery by repeat caesarean appears safer for women as the benefits of a slightly shorter duration of pregnancy include less morbidity associated with late pregnancy.