Once a cesarean section, always a cesarean section. That was the standard thinking for pregnant women years ago, but that standard has changed.
The concern used to be that during labor, a previous cesarean incision could potentially open up, called a uterine rupture. This is considered an emergency that can harm mom and baby. An immediate C-section is needed to deliver baby and repair the tear.
Doctors now know this rarely happens. In fact, the vaginal birth after cesarean (VBAC) success rate has been reported to be as high as 83 percent for women with a previous vaginal delivery and 94 percent for women with a previous VBAC.
Options for Women Who've Had a Previous C-Section
Now the options for women who have undergone a previous cesarean (c-section) delivery include:
- Proceed with a trial of labor after cesarean (TOLAC)
- If labor progresses well, proceed to a vaginal birth after cesarean (VBAC).
- If labor doesn’t progress well, switch to a cesarean section.
- Have a planned repeat cesarean delivery (PRCD)
A TOLAC should only be done in a hospital or center where a c-section can be performed right away, if needed. At CHI Health, women with a previous cesarean delivery and a history of vaginal birth (either prior vaginal delivery or VBAC) are encouraged to consider a TOLAC.
Benefits of a VBAC
Women often desire a TOLAC because a VBAC offers several benefits. These include a shorter post-birth hospital stay, less pain and shorter recovery, and fewer problems post-delivery compared to c-section (fever, infection, blood clot in leg, blood transfusion).
Many feel the benefits of a successful VBAC (avoiding multiple c-sections) outweigh the risk of attempting a TOLAC only to switch to a c-section when labor doesn’t progress or if there is concern about uterine rupture.
A trial of labor has the best chance of working when:
- You had a past vaginal delivery before or after a c-section.
- Your previous c-section was done for a baby in breech position (legs/buttocks first instead of head first)
A trial of labor is not recommended when:
- Incision from previous c-section was not done in the usual way
- Uterine rupture occurred with a past pregnancy
- Vaginal birth isn’t safe for mom or baby
These factors and more should be taken into consideration. You and your provider should discuss your personal preferences, obstetric history, scientific data on risks and benefits of TOLAC versus PRCD, and availability of TOLAC in your selected birth setting. Rather than assume you’re limited to a future c-section, it’s worthwhile to consider your options.
Reach out to your provider for more information and to discuss the best option for you.