Vaginal Birth After Cesarean

Most women who opt for TOLAC have a safe and successful VBAC delivery. The Women's Health team supports you.


Vaginal Birth After Cesarean

If you had a cesarean delivery (c-section) with your previous baby and want to try delivering your next baby vaginally, then a trial of labor after cesarean (TOLAC) might be right for you.

Our Women’s Health providers and birth center team support women who want to try a vaginal birth after a previous c-section.

Here’s what you need to know to make an informed decision.

Frequently Asked Questions

What is a TOLAC and a VBAC?

TOLAC is a Trial Of Labor After a Cesarean delivery. You are attempting to deliver vaginally. A successful TOLAC results in a Vaginal Birth After Cesarean (VBAC). The alternative to TOLAC is a repeat cesarean delivery.

What are the risks of a TOLAC?

  • Need for c-section while in labor
  • Risk of infection
  • Risk of blood loss
  • Uterine rupture (the previous uterine c-section scar breaks opens during labor). This is rare but can result in an emergency c-section and could pose serious harm to both you and the baby.

What are benefits of a VBAC delivery?

  • No surgery
  • Shorter hospital stay and recovery time
  • Less pain after delivery
  • Lower risk of infection
  • Lower risk of blood clots
  • Less risk of bowel or bladder injury
  • Less blood loss, lowering the risk of needing a blood transfusion
  • Decreased risk of complications with future pregnancies

How do I know if I am a good candidate for a TOLAC?

Many women have a successful VBAC delivery. Your provider can help you determine if you are a good candidate.

Your chance of a successful VBAC delivery is higher if:

  • You’ve had a vaginal delivery in the past
  • You go into labor on your own
  • You are healthy and not overweight
  • Your previous c-section was done for a reason that isn’t present this time (baby was breech, problems with baby’s heart rate)

Your chance of a successful VBAC delivery is lower if:

  • You have a vertical (or classical) incision on your uterus or if you’ve ever had a uterine rupture in the past. A VBAC is NOT recommended under these conditions
  • Your pregnancy goes past your due date
  • You have a very large baby
  • Your previous c-section was done for reasons that may recur such as labor that does not progress as expected

Why is the type of uterine incision used in my previous c-section important?

You have a scar on your skin and a scar on the wall of your uterus from your previous c-section. It’s the uterine scar that is important. You cannot tell the type of uterine scar you had by looking at the scar on your skin.

Some uterine scars are more likely than others to rupture during a VBAC delivery. The type of scar depends on the type of cut in the uterus:

  1. Low transverse—A side-to-side cut made across the lower, thinner part of the uterus. This is the most common type of incision and carries the least chance of future rupture.
  2. Low vertical—An up-and-down cut made in the lower, thinner part of the uterus. This type of incision carries a higher risk of rupture than a low transverse incision.
  3. High vertical (also called “classical”)—An up-and-down cut made in the upper part of the uterus. This is sometimes done for very preterm cesarean deliveries. It has the highest risk of rupture.

How do I find out what type of uterine incision I had from a past c-section?

Your operative report from your previous c-section should include this information. It is a good idea to get your operative report of your prior c-section so you and your Women’s Health provider can review them during your prenatal care. Your operative report should also show the type of incision closure that was used and the reason why you had a c-section. These are also important in making an informed decision.

If your previous c-section was at Northfield Hospital, your operative report will be available to your Women’s Health provider. If you delivered somewhere else, you should request that your c-section operative report be sent to your Women’s Health provider.

What if I end up needing a c-section?

We offer Family Centered C-Sections that provide mom, baby and support person with as close to a vaginal childbirth experience as possible. Bringing the desired features of a vaginal delivery into the operating room, such as listening to music, being able to see baby being born, and immediate skin-to-skin bonding, creates a more peaceful, calm and relaxing experience. Learn more about Family Centered C-Sections on our website.   

Most women who opt for TOLAC have a safe and successful VBAC delivery. For those whose trial of labor results in a c-section, our providers and Birth Center team are prepared to provide all the care you and your baby need. Discuss your questions and the risks with your provider to help you make the best decision for you and your baby.

Read more about VBAC delivery from the American College of Obstetrician Gynecologists is external)