Considering a VBAC? Understanding TOLACs and VBACs

If you've had a Cesarean birth (C-section) in the past, you might be wondering about your options for future deliveries. One option to consider is a Trial of Labor After Cesarean (TOLAC), with the goal of achieving a Vaginal Birth After Cesarean (VBAC). This blog post will break down what TOLAC and VBAC are, the benefits and risks involved, and what to consider when making this important decision.

What is TOLAC?

TOLAC stands for Trial of Labor After Cesarean. It means you're attempting to deliver vaginally after having had a previous C-section. Instead of scheduling a repeat C-section, you'll go into labor and your medical team will monitor you and your baby closely to see if a vaginal delivery is possible.

What is VBAC?

VBAC stands for Vaginal Birth After Cesarean. It's the successful outcome of a TOLAC – meaning you've delivered your baby vaginally after having had a previous C-section.

Why Consider TOLAC/VBAC?

There are several reasons why women choose to pursue a TOLAC/VBAC:

• Avoidance of Major Surgery: VBAC avoids the risks associated with repeat C-sections, such as infection, blood loss, and longer recovery times.
• Shorter Recovery: Vaginal deliveries generally lead to a faster recovery compared to C-sections, allowing you to bond with your baby and return to your normal activities sooner.
• Lower Risk of Complications in Future Pregnancies: Repeat C-sections can increase the risk of complications in future pregnancies, such as placenta previa and placenta accreta.
• Personal Preference: Many women desire the experience of a vaginal birth and feel empowered by achieving a VBAC.

Benefits of VBAC for the Baby:

• Exposure to Beneficial Bacteria: Vaginal birth exposes the baby to beneficial bacteria in the birth canal, which can help boost their immune system.
• Hormonal Benefits: The hormonal changes that occur during labor and vaginal birth can benefit the baby's respiratory system and overall development.

Risks of TOLAC/VBAC:

While VBAC offers many benefits, it's essential to be aware of the potential risks:

• Uterine Rupture: This is the most significant risk associated with TOLAC. It occurs when the scar from the previous C-section tears during labor. While rare, it can be serious for both mother and baby.
• Emergency C-section: If labor isn't progressing or if there are signs of distress in the mother or baby, an emergency C-section may be necessary.
• Infection: As with any vaginal delivery, there is a risk of infection.
• Hysterectomy: In rare cases, a hysterectomy (removal of the uterus) may be necessary if uterine rupture occurs and cannot be repaired.

Who is a Good Candidate for TOLAC/VBAC?

Not everyone is a good candidate for TOLAC/VBAC. Your doctor will assess your individual circumstances to determine if it's a safe option for you. Factors that may make you a good candidate include:

• One Prior Low Transverse C-section: This is the most common type of C-section incision and is generally considered the safest for TOLAC.
• No Other Significant Uterine Scars: Having other uterine surgeries, such as myomectomy (fibroid removal), may increase the risk of uterine rupture.
• Adequate Time Between Pregnancies: Ideally, you should have at least 18 months between your C-section and your next pregnancy.
• No Medical Conditions that Contraindicate Vaginal Delivery: Certain medical conditions, such as placenta previa, may make vaginal delivery unsafe.
• Baby is in a Head-Down Position: Breech presentation (baby's feet or buttocks first) is generally not conducive to VBAC.
• Hospital with Adequate Resources: You should deliver at a hospital that has the resources to handle an emergency C-section, including a surgical team and blood bank.

What to Discuss with Your Doctor:

If you're considering TOLAC/VBAC, it's crucial to have an open and honest conversation with your doctor. Here are some questions to ask:

• Am I a good candidate for TOLAC/VBAC?
• What are the specific risks and benefits for me?
• What is the hospital's VBAC success rate?
• What is the hospital's protocol for monitoring labor during TOLAC?
• What are the hospital's resources for handling an emergency C-section?
• What are my options if TOLAC is not successful?

Making the Decision:

Deciding whether to pursue TOLAC/VBAC is a personal one. It's important to weigh the benefits and risks carefully and discuss your options with your doctor. Consider your individual circumstances, your medical history, and your personal preferences.

TOLAC/VBAC can be a safe and empowering option for women who have had a previous C-section. By understanding the benefits and risks, and by having an open conversation with your doctor, you can make an informed decision that's right for you and your baby. Remember to choose a supportive care provider and a hospital equipped to handle both vaginal births and emergency C-sections. Reach out to our CHI Health Women's Health team with more questions.