A rare vaginal birth after four caesarean sections: a case report of a rural area Authors Sumaira Azam Khattak Department of Obstetrics and Gynaecology, District Headquarters Hospital, Landikotal, Pakistan DOI: https://doi.org/10.47391/JPMA.22190 Keywords: Normal vaginal delivery (NVD), vaginal birth after Caesarean-section (VBAC),, caesarean section (CS), lower uterine segment (LUS), Appearance, Pulse, Grimace, Activity and Respiration (Apgar score) Abstract Vaginal Birth after Caesarean section (VBAC) is an approach to promote normal deliveries and decrease the growing inclination towards Caesarean Section (CS). Attempts at normal vaginal deliveries are now considered conclusive for proceeding in women with a history of caesarean section. Although there are potential risks involved, clinical practice often favours repeat caesarean sections. This case report highlights a prospective approach towards the normal vaginal delivery in patients with a history of multiple CS. This case report describes a rare case of a 32 -year-old patient with four previous caesarean sections, who was admitted as an emergency case at the government hospital, District headquarters Landikotal, Peshawar, District Khyber. She had no scheduled antenatal care, and no previous antenatal records were available. Despite this, she experienced a spontaneous advanced vaginal delivery. There were no signs of previous caesarean scar rupture, and full dilatation of 10cm was achieved. Keywords: Normal vaginal delivery (NVD), vaginal birth after Caesarean-section (VBAC), caesarean section (CS), lower uterine segment (LUS), Appearance, Pulse, Grimace, Activity and Respiration (Apgar score). Downloads Full Text Article Published 2025-09-25 How to Cite Azam Khattak, S. (2025). A rare vaginal birth after four caesarean sections: a case report of a rural area. Journal of the Pakistan Medical Association, 75(10), 1614–1616. https://doi.org/10.47391/JPMA.22190 More Citation Formats ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver Download Citation Endnote/Zotero/Mendeley (RIS) BibTeX Issue Vol. 75 No. 10 (2025): OCTOBER Section CASE REPORT License Copyright (c) 2025 Journal of the Pakistan Medical Association This work is licensed under a Creative Commons Attribution 4.0 International License.