Vaginal Birth After C-section: Deciding if a Trial of Labor is Right for You

In the United State approximately one-third of all first-time mothers are delivered via c-section. If you have had a c-section in the past, you have the option of choosing a repeat c-section (usually scheduled no more than 7 days before the due date) or to attempt a vaginal delivery. Your doctor will discuss vaginal birth after c-section or “VBAC” with you. Another common term used is “trial of labor after c-section” or “TOLAC”.

At Peachtree Women’s Clinic, you have the option of choosing to attempt a vaginal delivery if you have had one previous c-section. Women who are good candidates for attempting TOLAC include:

• Women who received a c-section for reasons not related to failure to dilate or because the baby was too large to fit through the pelvis
• Women who received a “low transverse” c-section, where the uterus is cut in a horizontal direction
• Women who go into labor on their own

Women who may not be good candidates for attempting TOLAC include:

• Women who have had two or more c-sections
• Women who have had a “classical” c-section where the uterus is cut in a vertical direction
• Women who have gone past their due date without showing any signs of cervical dilation
• Women with a very large baby

Below are some common questions asked by women considering VBAC or TOLAC:

Why do some women choose to attempt a vaginal delivery after having a c-section?

Having a c-section is major abdominal surgery. After 3 or more c-sections, the risk of complications including injury to the bladder or bowel, severe bleeding or even requiring hysterectomy at the time of delivery increase dramatically. Recovery from a c-section often takes 6-8 weeks. Vaginal delivery usually involves less risk of injury, less blood loss and a shorter recovery when compared with c-section.

What are the risks associated with VBAC?

The biggest risk associated with VBAC is uterine rupture, which occurs in less than 1% (approximately 1 in 300) of VBAC attempts. Uterine rupture occurs when the old scar on the uterus separates, requiring an emergency delivery with risks to the mother and the baby. It is important to discuss TOLAC/VBAC with your doctor, as this complication is rare but serious.

It is important to discuss TOLAC/VBAC options during pregnancy as well as around the time of delivery, as certain conditions or situations may affect your decision.