The old phrase "once a C-section always" is no longer true. In the past, the belief was that if a woman had delivered one baby by C-section, all other children had to be delivered the same way. Today many women can have vaginal deliveries after a previous C-section delivery. This is referred to as a vaginal birth after cesarean (VBAC). Attempting to have a vaginal birth after a previous cesarean section is called a trial of labor after cesarean (TOLAC).
According to the American College of Obstetricians and Gynecologists (ACOG), the following women are candidates for TOLAC:
ACOG has specifically stated that whenever a woman is planning a TOLAC delivery, there should be an appropriate medical team available, including an anesthesiologist, throughout the active labor so that an emergency C-section may be done if necessary. Smaller hospitals may not have the resources to monitor a VBAC delivery or to provide an emergency c-section for TOLAC situations, and VBAC delivery may not be possible.
One of the main concerns with having a vaginal delivery after a C-section is the potential rupture of the uterus, which could be harmful to you and the baby. Therefore, ACOG has made recommendations for women who should not try a VBAC delivery. These women include:
Statistically, about 60-80% of women who try TOLAC are able to deliver vaginally. If you are considered a candidate for VBAC, there are some advantages to having a vaginal delivery over a C-section. Some of these include:
Notably, however, some women who try to have a vaginal delivery end up with a c-section. They don’t get to experience these benefits.
The most serious risk with TOLAC is rupture of the uterus. The risk of rupture of the uterus after a prior low transverse c-section is about 1 percent, whereas the risk of rupture of the uterus in previous classical C-section is 8 to 10 percent. In a recent large study, about 1 in 2,000 women who tried to TOLAC had a uterine rupture that caused permanent brain damage for the baby. Women in the group that tried to have a vaginal delivery were also more likely to need a blood transfusion and more likely to have an infection in their uterus that required antibiotics. On the other hand, about three quarters of the women who tried to have a vaginal delivery succeeded. These women avoided surgery and had a quicker recovery compared with the women who chose to have a scheduled repeat c-section.
The key to making a decision about TOLAC is to discuss with your health care provider the risks and benefits for both you and your baby. The circumstances are different for everyone, and it is important to seek guidance from your health care provider to discuss your risks.
Ultimately, the decision is yours. The more information and understanding you have about TOLAC, the easier it will be to make a decision.
Reviewed By: Irina Burd, MD, PhD, Maternal Fetal Medicine, Johns Hopkins University, Baltimore, MD. Review provided by VeriMed Healthcare Network.