Trial of Labor after Cesarean (TOLAC)

So you had a cesarean for your first delivery and now you are pregnant again.  One of the major questions you will make with your OB is what type of delivery, vaginal birth after cesarean (VBAC) or repeat cesarean, is most reasonable.  How do you make that decision? If we had crystal ball it would be so easy, but we don’t, so let’s look at all the factors that influence the decision.

Risks to consider

After a cesarean there is a scar on the uterus. That area is just a little weaker than the rest of the uterus.  As the uterus grows and stretches this area gets thinned out and even weaker.  Labor contractions put even more stress on the scar.  All this increases the risk that the scar can break open, or what we term “uterine rupture”.  If the scar ruptures, the blood flow to the baby can be compromised and sometimes cause permanent neurologic problems for the baby, or even death.  The risk of these are extremely low.  Only half of a percent of women laboring after a previous cesarean will have rupture.  Of those that rupture approximately 3 percent (and remember this is 3% of 0.5% total ruptures) will have complications or fetal death.  Because this number is so low, it is reasonable to consider a trial of labor in appropriate patients.

So what makes a patient appropriate?

Things your provider is considering when they are counseling you about a TOLAC include the reason for your cesarean, baby’s weight as well as your height and weight, whether or not have you had a vaginal delivery, and your ethnicity.  All of these can affect the potential success of a TOLAC.  There are online calculators that will give you the chance of a successful vaginal delivery.  Additionally we factor in how many more pregnancies you are considering. The final factor is what do YOU want.  Sometimes in your gut you know how you want to deliver. Realize there is no wrong or right.  Your provider will always guide you away from a overly risky option.


Many women fear the recovery with another baby at home.  Surprisingly most women do really well after a repeat cesarean.  Certainly if you labored last time, then had a c-section while you were both mentally and physically exhausted, the recovery of a repeat may seem easier even if you have other children at home.

It’s a big decision and no gut instinct, physician or VBAC calculator can always predict a successful vaginal delivery, all of these tools will guide you into a decision that makes you and you provider are comfortable.  End of the day the goal is a healthy baby and a healthy mom!!