It was once thought that if a woman had one cesarean delivery, all other babies she had should be born in the same way. Today, it is known that many women can undergo a trial of labor after a cesarean delivery (called TOLAC). After a successful TOLAC, many women will be able to give birth through the vagina (called a vaginal birth after cesarean delivery, or VBAC).
TOLAC is not the right choice for every woman, but it is a good choice for many women. It is important to understand the risks and benefits before deciding to attempt TOLAC and VBAC.
A woman who has had a previous cesarean delivery has the following choices when planning how to give birth again:
- She can have a scheduled cesarean delivery.
- She can try to have a VBAC. If a woman wants to try VBAC and is considered a good candidate, she will undergo TOLAC.
Of women who undergo TOLAC, 60–80% succeed and are able to give birth vaginally. But if problems arise during TOLAC, the baby may need to be born by emergency cesarean delivery. For example, if the baby is not tolerating labor, or if labor does not progress, an emergency cesarean delivery may be needed. There are more risks, such as a greater risk of infection, with having an emergency cesarean delivery after TOLAC than having a planned cesarean delivery. The least number of risks occur with a successful VBAC.
Reasons to Consider TOLAC
There are many reasons why a woman may want to consider TOLAC. Compared with a planned cesarean delivery, a VBAC after successful TOLAC is associated with the following benefits:
- No abdominal surgery
- Shorter recovery period
- Lower risk of infection
- Less blood loss
For women planning to have more children, VBAC may help them avoid problems linked to multiple cesarean deliveries. These problems include hysterectomy, bowel or bladder injury, and certain problems with the placenta.
Both TOLAC and repeat planned cesarean delivery have risks. Both can cause infection, injury, blood loss, and other complications. With TOLAC, the risk of most concern is the possible rupture of the cesarean scar on the uterus or the uterus itself. Although a rupture of the uterus is rare, it is very serious and may harm both mother and baby. If a woman is considered at high risk of rupture of the uterus, TOLAC should not be tried.