Dissertation (MMED Obstetrics and Gynaecology)Background: The rate of Cesarean section has been increasing worldwide. In Tanzania the rate has doubled from 3% in 2004/2005 to 6% in 2015/2016. Previous Cesarean section as an indication for repeat Cesarean Section has increased from 7.2% in 2000 to 17% in 2011, repeat cesarean section is associated with long term complications like placenta accrete, hemorrhage, uterine rupture and a high fetal and maternal morbidity and mortality. Vaginal birth after Caesarean Section (VBAC) is an acceptable mode of delivery. However, in current practice VBAC is now replaced by repeat caesarean section. Objective: This study aimed to determine the predictors and outcomes of women attempting Vaginal Birth After Cesarean delivery at Iringa Regional Referral Hospital. Methods: Hospital prospective cohort study on women with one previous scar with gestation age >28 weeks. The sampling method was purposive and involved all women with one previous scar presenting at the hospital during the study duration. Data was analyzed by using SPSS version 20. Results: 132 patients with one previous scar were involved in the study, 40(30%) patients were low risk and therefore eligible for Trial Of Labor After Cesarean (TOLAC) delivery, 41(31%) had Elective Repeat Cesarean Section (ERCS), and 51 had Emergency Repeat Cesarean Section (EmRCS). The success rate of VBAC was 55%, the main predictors of VBAC were maternal age of < 25 years and birth weight of < 3 Kg. Advanced cervical dilation, station of presenting part, spontaneous membrane rupture, gestation age <38 had clinical effect on TOLAC though was not significant. The rate of scar dehiscence was 5%, hysterectomy was 5% and post partum hemorrhage with blood transfusion was 7.5%. Maternal and neonatal outcomes of women undergoing TOLAC and ERCS were similar. Conclusion: The rate of Successful VBAC is 55%, the significant predictors are maternal age and fetal birth weight. Women who undergo TOLAC may develop complication such as scar dehiscence, postpartum hemorrhage and may have peri-partum hysterectomy. Neonates of women who undergo TOLAC may have low score. The maternal and neonatal outcomes are similar to those of women undergoing ERCS.