Trial of Labor After Cesarean (TOLAC)







After delivery by Cesarean section, a woman may choose to have a planned Cesarean birth or choose a trial of labor for vaginal birth (VBAC-vaginal birth after Cesarean).  It is likely that 70-80% of women who have a trial of labor after Cesarean (TOLAC) will be successful.  Your provider's at Avalon want you to understand the risks and benefits of your choices.  There is a certain amount of risk with every pregnancy.  We share the same goals as you and your partner—a healthy baby and a healthy mom.  We will make every effort to ensure this outcome.

Can all women with a previous Cesarean delivery attempt a TOLAC?

Some women should not attempt a VBAC. If the Cesarean scar is in the upper part of the uterus where the muscles contract, the risk of the uterus tearing (uterine rupture) is high. These women should have repeat scheduled Cesareans and avoid labor. Women with a low transverse uterine incision have a lower risk of uterine rupture and are considered good candidates for TOLAC. The type of scar you have on your skin may not be the same type of scar on the uterus.  We will request that you obtain your operative record from your previous Cesarean delivery in order for us to assess the type of uterine incision that was done, and the uterine suture technique (single vs. double layer).  If you have had more than 2 Cesarean deliveries, the risk of uterine rupture is increased. For this reason, we do not offer TOLAC to women with more than 2 Cesarean sections.

What are the benefits of TOLAC compared to a repeat Cesarean section?

What are the risks of TOLAC?

What are the risks?

If I choose a repeat Cesarean delivery, what can I expect during my recovery?

Each woman has her own unique experience with Cesarean delivery and recovery. Many women report that they felt their recovery was easier the second time than after their first Cesarean delivery. This may be due to knowing what to expect afterward, and feeling less fatigued since there was no labor.  Still, recovering from major abdominal surgery takes time, and there are restrictions to your activity for several weeks.

How do the risks of TOLAC compare to repeat Cesarean delivery without labor?

What are the chances that a TOLAC will result in a vaginal birth?

How can I reduce risks and increase my chances of a successful VBAC?

Making a decision—TOLAC vs. repeat Cesarean delivery

Avalon/Atlantic Health System Policies Concerning TOLAC