Child Birth Delivery

Many mothers who have had a cesarean section (C-section) delivery are under the impression that once you have a C-section, you must always have a C-section with any future pregnancies. However, for pregnant mothers who have had one or two previous C-sections, a trial of labor known as Trial of Labor After Cesarean (TOLAC) may also be a viable option.

You may have also heard the term: VBAC. Once someone has successfully had a vaginal delivery after a C-section, it is called a vaginal birth after cesarean (VBAC).

Who is Eligible for TOLAC?

Most patients are eligible for TOLAC, though some patients may be better candidates than others. To determine your eligibility, your provider will go over your previous C-section and the reason it occurred, as well as any complications that occurred during the surgery or during your pregnancy.

The reason for your previous C-section as well as any complications in your current pregnancy will all impact your chance of TOLAC in this pregnancy. Having a high chance of success is important because an unplanned repeat C-section delivery (or failed TOLAC) is the least safe birthing option.

Some people are not candidates for TOLAC due to the type of C-section delivery they had with their last delivery, a history of extensive uterine surgery (like a myomectomy) or current pregnancy complications that would prevent a vaginal delivery. If a previous provider has ever said that you should not attempt a vaginal delivery after your C-section, it is important to discuss that with your provider in your current pregnancy.

How Safe is TOLAC?

The safest way to deliver after a previous C-section is TOLAC resulting in a VBAC.

Vaginal delivery is associated with a reduced risk of blood loss and infection and a decreased hospital stay, among other benefits. On the other hand, having multiple C-sections can lead to scar tissue and adhesions, increasing the risk of injury during surgery.

The biggest risk of TOLAC is a uterine rupture, which occurs only about 1% of the time. Though rare, a uterine rupture is an emergency for both mother and baby, which could result in blood loss, complications for baby or for the need for a hysterectomy if the rupture cannot be repaired.

Is TOLAC the Best Option for Baby and Me?

There are many factors that you may want to consider when thinking about your decision to opt for TOLAC or have a repeat C-section. These include, but are not limited to:

  • Previous surgical history
  • Chance of success for TOLAC
  • Future childbearing and desired family size
  • Past delivery experiences

The decision to TOLAC or have a C-section is very personal. At UofL Health, we strive to understand your previous delivery experiences and current pregnancy desires to help you have the healthiest and happiest delivery experience possible. Your provider with UofL Physicians – OB/GYN & Women’s Health is here to support you every step of the way.

Interested in learning more about TOLAC? Call 502-588-4400 to make an appointment with an obstetrician at UofL Physicians – OB/GYN & Women’s Health.

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Article by: Caitlin Thomas, M.D.

Caitlin Thomas, M.D., is a general obstetrician and gynecologist with UofL Physicians – OB/GYN & Women's Health and an assistant professor in the Department of Obstetrics, Gynecology and Women’s Health at University of Louisville School of Medicine. She received her master of science and her medical degree at University of Louisville, then completed a residency and internship in obstetrics and gynecology at Indiana University. Dr. Thomas’s areas of interest include contraceptive management, gender-affirming care and laparoscopic surgery. She strives to provide inclusive and compassionate service.

All posts by Caitlin Thomas, M.D.
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