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Vaginal Birth Post Cesarean

Deciding on a Trial of Labor After Cesarean Delivery

What is a vaginal birth after cesarean delivery (VBAC)?
What is a trial of labor after cesarean delivery (TOLAC)?
What are the some of the benefits of a TOLAC?
What are the risks of a TOLAC?
Why is the type of uterine incision used in my previous…
What other factors should be considered when deciding…
Whatever I decide, are there things that can happen…

What is a vaginal birth after cesarean delivery (VBAC)?

  • If you have had a previous cesarean delivery, you have two choices about how to give birth again:
    • You can schedule a cesarean delivery
    • You can give birth vaginally
  • VBAC stands for vaginal birth after cesarean delivery

What is a trial of labor after cesarean delivery (TOLAC)?

  • A trial of labor after cesarean delivery (TOLAC) means
    • An attempt to have a vaginal birth after cesarean delivery

What are the some of the benefits of a TOLAC?

  • Compared with a planned cesarean delivery, a successful TOLAC is associated with the following benefits:
    • No abdominal surgery
    • Shorter recovery period
    • Lower risk of infection
    • Less blood loss
  • If you want to have more children, VBAC advantages include:
    • Avoiding problems linked to multiple cesarean deliveries such as
      • Increased probability of hysterectomy
      • Injury to bowel or bladder
      • Placenta problems

What are the risks of a TOLAC?

  • Possible rupture of the cesarean scar on the uterus
  • Rupture is rare, but if occurs is serious to you and your baby
  • If you are at risk, you should not use TOLAC

Why is the type of uterine incision used in my previous…

  • Some types of uterine incisions are more likely to cause rupture
    • Low transverse (side to side) incisions carry the least chance of rupture
    • Women who have had one or two previous cesarean deliveries with this type of incision can try TOLAC
    • High vertical (up and down) incisions carry the most chance of rupture
    • Women who have this type of incision should not try TOLAC

What other factors should be considered when deciding…

  • In addition to the type of incision, you should also consider:
    • Do you want more children
    • Do you have any medical complications that makes vaginal delivery risky
    • What hospital you will be using
      • Can your hospital deal with any emergency that might arise
    • Have you had a uterine rupture
      • If so, TOLAC is not advised
    • What about future deliveries
      • Multiple cesarean deliveries bring potential risks

Whatever I decide, are there things that can happen…

  • Be prepared for changes to your delivery plan
  • If you have chosen TOLAC, things can happen during pregnancy and labor
    • This will alter the balance of risks and benefits
      • You may need to have your labor induced
      • This can reduce the chances of a successful vaginal delivery
      • And perhaps increase the chance of complications during labor
  • In the event that circumstances change, you may have to reconsider your decision
  • If you have chosen a repeat cesarean delivery, in some situations, TOLAC may be advised
    • For example, if you have planned a cesarean delivery but go into labor before your scheduled surgery
    • It may be best to consider TOLAC if you are far along in your labor and your baby is healthy

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