What you should know about TOLACs

For many women who have had a C-section at the end of a previous pregnancy, future vaginal births are a good, healthy delivery option. It’s not always possible to tell which pregnancies are good candidates for future vaginal births, but for women who might be, a healthcare provider may recommend a TOLAC, or trial of labor after Cesarean section. Most women are candidates for TOLACs.

A large proportion of women who have had previous C-sections are strong candidates to try for vaginal births after Cesareans. Of the women who do try, between 60 and 80% of them successfully deliver vaginally. This is known as a VBAC (vaginal birth after C-section).

It’s true that women who do face complications from previous C-sections may potentially experience danger during labor. On the other hand though, the vast majority of women going for VBACs have generally healthy, positive experiences.

There is a chance of uterine rupture

Uterine rupture, or tearing along the scar from a previous C-section, is a rare but serious side-effect of TOLAC. Uterine rupture can cause heavy bleeding and potential infection, hemorrhage, and the chance of damage to other organs and structures in the mother, potential brain damage in the baby, and can increase the chances of hysterectomy, or removal of the uterus, as well as a chance of maternal and fetal death.

However, women in general have a less than 1% chance of uterine rupture, and women who have had previous vaginal births have an even lower risk than that. Uterine rupture is most common in women with vertical C-section scars or prior uterine surgery that enters the thick part of the uterine wall, which is why these women are generally not recommended to try to labor.

Not all hospitals support them

Hospitals that are not equipped to be ready to transfer a mother in a TOLAC to a C-section at a moment’s notice do not offer TOLACs, even to women who would otherwise be good candidates for one. This is because of the risk of uterine rupture, as well as other risks associated with TOLACs. If you would like a TOLAC, it’s a good idea to discuss it with your healthcare provider early on. If you’re a good candidate for a TOLAC, an early discussion will leave plenty of time to switch to another provider or another hospital if your provider or hospital doesn’t offer the chance for the kind of birth you’d like to try.

  • Mary M. Murry. “To VBAC or not to VBAC?” MayoClinic. Mayo Clinic. February 19 2010. Web.
  • Mayo Clinic Staff. “VBAC: Insights from a Mayo Clinic Specialist.” MayoClinic. Mayo Clinic. July 2 2015. Web.
  • “Vaginal Birth After Cesarean (VBAC).” BrighamandWomens. Brigham And Women’s Hospital. September 18 2015. Web.
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