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Vaginal Birth Often Possible Despite Previous C-Sections

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This article was written by UAB Medicine OB/GYN and Maternal-Fetal Medicine specialist William Perez, MD.

Will a TOLAC succeed?Roughly 1 in 3 women in the United States deliver their baby by cesarean section. In the past, it was recommended that women with a prior cesarean delivery should give birth this way in subsequent pregnancies.

However, many women prefer vaginal birth and wish to avoid repeat cesarean sections. At UAB Medicine, most women are candidates for vaginal birth, even if they’ve had one or two cesarean deliveries previously.

There are many reasons patients and their health care providers may wish to avoid another cesarean delivery. It is well known that each additional cesarean increases the chances of significant blood loss, the need for a blood transfusion, longer surgeries, internal scar tissue, damage of internal organs during surgery, the need for a hysterectomy around the time of delivery, and other complications.

In addition, we have seen an increase in the number of pregnancies that implant near the uterine scar from the previous cesarean. This can lead to a life-threatening emergency or require a hysterectomy. On a more practical note, the recovery from a vaginal birth tends to be shorter, and women are able to more easily return to daily activities when compared to a cesarean birth.

For these and other reasons, many women request a trial of labor after cesarean (TOLAC). 

Will a TOLAC Succeed?

There are certain factors to consider when counseling women on the likelihood of a successful vaginal birth after cesarean, but we cannot accurately predict who will succeed. The TOLAC success rate nationally is about 70%.

The good news is that a TOLAC is generally considered to be a safe option. The choice of a TOLAC vs. a repeat cesarean should be based on each woman’s medical history, current pregnancy complications, and personal wishes.

However, not all women are not good candidates for a TOLAC. If a woman has had more than two previous cesarean deliveries, or if her previous uterine incision extended into the more muscular portion of the uterus, we recommend a repeat cesarean.

Also, while UAB Medicine supports women in their choice to undergo a TOLAC, the provider or the mother may abandon the labor trial and proceed with cesarean – especially if the health of the mother or baby is threatened. The UAB Women and Infants Center provides 24-hour access to anesthesia, obstetric, and surgical services, making it easier and safer to switch to a cesarean delivery if a TOLAC fails or suddenly becomes too risky.

If you wish to undergo a TOLAC, do not hesitate to discuss it with your prenatal provider. Below are some questions to ask yourself or your doctor:

  • Am I a good candidate for a TOLAC? Why or why not?
  • What are the risks of a TOLAC? Can you compare these to cesarean delivery risks?
  • What is placenta accreta?
  • What is cesarean scar pregnancy?
  • How many children do I plan to have?
  • Are there other indications for surgery? (i.e. ovarian cyst removal, tubal ligation)

Click here to learn more about cesarean section surgery, and click here to learn more about UAB Women & Infants Services.