Some women who give birth by C-section worry about whether or not they’ll be able to give birth vaginally down the road. The truth is that while many women who have had C-sections do go on to have more of them, many others go on to have healthy, safe vaginal deliveries in the future. The odds of giving birth vaginally after a C-section can be good, depending on the reasons for previous C-sections.
About 90% of women who have had C-sections are good candidates for trial of labor after C-section, often called TOLAC. A successful birth following a TOLAC is known as a VBAC (vaginal birth after C-section). Depending on which study you look at and, often, the hospital where you’re planning to deliver, planning VBACs have a 60 to 80% chance of successful vaginal delivery.
In short, it’s not only that you often can have a vaginal delivery after a C-section, but it’s often a good choice to do so.
Why choose to plan a TOLAC?
The main reason a TOLAC can be a positive choice for moms who have had previous C-sections is that it’s a potential alternative to another major abdominal surgery. These can lead to longer hospital stays, longer recovery times, and the risk that always comes with anesthesia.
Additionally, women who plan to have future pregnancies may choose to try for a TOLAC if possible, because repeated deliveries by C-section can cause risks like an increased risk of injuries to the bowel and bladder, or of placenta accreta in a subsequent delivery.
Finally, many women want vaginal deliveries for personal reasons, and can find the experience of a VBAC more satisfying. Having a friend, partner, doula, midwife, or other consistent support person present through a VBAC can help with getting the most out of the experience, while at the same time cutting down on stress.
What makes somebody a good candidate for a TOLAC?
Many women are good candidates for TOLAC, particularly those whose pregnancies share the following traits:
- No other history of uterine surgery than previous C-sections
- Have not experienced uterine rupture, or extensive uterine surgery like fibroid removal
- No more than 1 or 2 previous C-sections
- A low, horizontal incision (on the uterus, not skin) was used in their previous C-section
- No recurrence of the medical reason that led to the previous C-section in this pregnancy
- No contraindications to a vaginal delivery
- Planning to give birth somewhere with 24-hour access to an emergency C-section if needed
Who might a TOLAC not be right for?
Depending on the hospital, women who have had more than two C-section deliveries may not be considered good candidates for TOLACs
- Women whose prior C-sections incisions were vertical (or “classical”) instead of low and horizontal along the abdomen
- Women who have experienced a prior uterine rupture, which increases the chances of uterine rupture in the future
- Women whose pregnancies last past their due date
- Women carrying unusually large babies
- Women carrying multiples
Your doctor will take all of your risk factors into count before determining whether a TOLAC might be right for you.
What are the risks of a TOLAC?
The most common risk, if a TOLAC fails, is a repeat C-section, which comes with all of the risks of major surgery, plus an increased risk of further complications during delivery for future pregnancies. In some rare cases though, there is also a chance of uterine rupture, when the area around the incision scar from the previous C-section starts to thin under stress, and eventually tear. In the case of a uterine rupture, an immediate emergency C-section would be needed to prevent potentially life-threatening health concerns.
Other risks include blood loss, infection, and damage to surrounding organs.
If you think you might be interested in trying for a TOLAC, it’s a good idea to discuss it with your healthcare provider ahead of time. Your provider will be able to tell you if you’re a candidate, and since healthcare providers have different levels of comfort assisting in TOLACs, you’ll be able to assess whether your provider, or the hospital they deliver at, is a good fit for your goals surrounding giving birth.
Sources
- Mayo Clinic Staff. “Vaginal birth after C-section: Risks.” Mayo Clinic. Mayo Clinic, June 12 2015. Web.
- Sally C. Curtin, et al. “Maternal Morbidity for Vaginal and Cesarian Deliveries, According to Previous Cesarian History: New Data from the Birth Certificate, 2013.” National Vital Statistics Report. Center for Disease Control. Web. May 20 2105.
- Robert M. Silver, et al. “Maternal Morbidity Associated with Repeat Cesarian Deliveries.” Obstetrics & Gynecology. 10.1097/01.AOG.0000219750.79480.84. Web. June 2006.
- Committee on Obstetric Practice. “Committee Opinion: Placenta Accreta.” American College of Obstetricians and Gynecologists. Web. July 2012, reaffirmed 2015.
- Cynthia S. Shellhaas, et al. “The Frequency and Complication Rates of Hysterectomy Accompanying Cesarean Delivery.” Obstet Gynecol. 10.1097/AOG.0b013e3181ad9442. Web. August 2009.
- “Vaginal birth after cesarian.” MarchofDimes. March of Dimes. August 2015. Web.
