Women who have undergone a cesarean section often have questions about the safety of attempting a vaginal birth in the future. The safety of a trial of labor after cesarean section (TOLAC) has been the subject of debate for many years.
A successful TOLAC is one that ends with a vaginal delivery after cesarean section (VBAC).
Not every woman that has previously undergone a cesarean section is considered a good candidate for a TOLAC. The American College of Obstetricians and Gynecologists (ACOG) considers the following women ideal candidates for a TOLAC:
- Those in which a low, transverse, uterine incision was made during the cesarean section
- Those who have had a previous vaginal delivery, especially after a cesarean section (a VBAC)
- Those who have had only one cesarean section
- Those that go into labor on their own (not induced)
- The previous cesarean section was performed because of baby’s position (breech, transverse)
- The cesarean section was performed when the woman was in early labor
- Labor begins before the pregnancy is post-dates (overdue)
- Those that have no medical conditions, such as high blood pressure, diabetes, heart conditions, and kidney disease
What are the risks?
Delivery of a baby by cesarean section requires an opening (incision) to be made within the uterus. After baby is delivered, the opening is closed by sutures (sewing). When a woman becomes pregnant again, there is a risk of her uterus rupturing (tearing apart) in the area that it was cut (incision site) when she is in labor. If the uterus ruptures, it is a medical emergency. An emergency cesarean section must be performed within minutes of the rupture, otherwise, the baby will not survive. The life of the mother may also be at risk due to a large amount of blood loss.
Women who deliver in larger, teaching hospitals have a higher TOLAC success rate compared to those that attempt a trial of labor after a cesarean section in a smaller, non-teaching hospital.
A trial of labor after cesarean section should only be considered in hospitals that have the necessary medical professionals immediately available if an emergency cesarean section is needed.
The decision to attempt a trial of labor after cesarean section is one that is made between a woman and her physician, taking into consideration the risks involved for Mom and Baby.