shared decision making: before labor & delivery

TOLAC & VBAC

If you have had a previous C-section, you may be considering having a repeat C-section or trying a vaginal delivery.

What Is a TOLAC?

TOLAC is an acronym that stands for Trial of Labor After Cesarean delivery. It means that a woman who has had a previous C-section attempts to have a vaginal birth.

What Is a VBAC?

VBAC is an acronym that stands for Vaginal Birth After Cesarean delivery. It means that a woman who has had a previous C-section has a vaginal delivery.

What’s The Difference?

A VBAC is a successful TOLAC.

What Are The Risks of a TOLAC?

The chances that a TOLAC will not work ranges from 20-40%. If the TOLAC does not work, your care team will then do a C-section. The most serious risk related to a TOLAC is that the cesarean scar on the uterus may rupture (tear open). If this happens, your doctor will do an emergency C-section. The risk of uterine rupture ranges from 0.2-9% depending on the type of uterine incision you have. One thing to remember is that the type of incision on the skin can be different than the type of incision in the uterus. While uterine rupture is rare it can be life threatening for mother and baby. If you are at high risk for a uterine rupture, a TOLAC is not advised.

What Are The Benefits of a VBAC?

Compared to a planned C-section, a VBAC is associated with a shorter recovery period, a lower risk of infection and less blood loss. If you plan to have more children, a VBAC may help you avoid problems linked to multiple C-sections.

What Factors Should I Consider When Deciding?

●     The type of incision from a previous C-section: Some incisions are more likely to cause uterine rupture.

●     Your plans for future children: Multiple C-sections are associated with additional risks in future deliveries.

●     Prior uterine rupture: If this has happened before, a TOLAC is not advised.

●     Pregnancy complications: Conditions that make a vaginal birth risky may make a TOLAC less advisable.

Could My Delivery Plan Change?

If, after weighing the risks and benefits, you decide to go ahead with a TOLAC, be prepared to rethink your decision if something happens that makes proceeding with a TOLAC less advisable. For example, inducing labor may make a successful vaginal birth less likely. On the other hand, if you are planning to have a repeat C-section but go into labor before your scheduled date, a TOLAC may be a better option if your baby is healthy and you are far along in labor.

Regardless of which option you choose -- a TOLAC or a repeat C-section -- if your circumstances change along the way, you and your care team will decide together how best to proceed.