Despite the best efforts of all involved, your child's birth doesn't always go down the way you may have planned. The best you can do is set yourself up to be in the most competent of hands while labor and delivery occurs. For example, if you underwent an unplanned cesarian birth for your first baby, you may yearn to go the vaginal route for your second. But if you had a C-section can you have a natural birth after? Or are you destined to have another major surgery every time you want to bring a baby into the world? Everyone's reasons behind their labor and delivery decisions are personal, but generally, a major plus to the vaginal birth is a shorter recovery time and hospital stay, so here's what you need to know about your options.
Experts say that for many women who delivered a baby via C-section, and who are pregnant again, attempting a vaginal birth after C-section (also called a VBAC) is, indeed, an option. And, if we are discussing a VBAC, we should also talk about the TOLAC. The term, TOLAC stands for "trial of labor after cesarean." The American College of Obstetrics and Gynecology (ACOG) defines a TOLAC as "the attempt to have a vaginal birth after a cesarean delivery." The difference between the two terms is that the TOLAC is the "trial" and the VBAC implies the successful vaginal delivery. So in short, a TOLAC is the act of attempts to have a VBAC.
The Mayo Clinic explains further, saying, "research on women who attempt a TOLAC shows that about 60 to 80 percent have a successful vaginal delivery." According to the American Pregnancy Association (APA), 90 percent of women who have had C-sections are candidates for VBAC. So the odds are pretty great that, for the right candidate, a vaginal birth could be in the cards even if the pregnant woman in question has had a C-section during a prior birth.
In 2010, ACOG updated their guidelines on VBACs in light of the rising rate of C-sections in the US at that time (32.3 percent of all births) and the declining rate of VBACs. The updated guidelines state that, "attempting a VBAC is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans." It also includes in their eligible candidates, women who have had two previous low-transverse cesarean incisions and women carrying twins. The revised guidelines highlight the benefits of the VBAC, which include avoiding major abdominal surgery, lowering the risk of hemorrhage and infection, and shortening postpartum recovery. They also note that a VBAC may also help women avoid the possible "future risks related to having multiple cesareans, such as hysterectomy, bowel and bladder injury, transfusions, infection, and abnormal placenta conditions."
There is, of course, the chance that your attempt at VBAC will fail, thus resulting in a repeat C-section. According to ACOG, "most maternal injury that occurs during a TOLAC happens when a repeat cesarean becomes necessary after the TOLAC fails. A successful VBAC has few complications than an elective repeat cesarian while a failed TOLAC has more complications than an elective repeat cesarean." That's enough to keep you up at night, more than that pregnancy acid-reflux, right?
A follow-up paper published on the National Institute of Health's (NIH) website shortly after the ACOG's guidelines were released, also concluded that a TOLAC is a "reasonable option for pregnant women with one prior low transverse uterine incision." But they also note that the data in their report showed that both TOLAC and elective repeat c-section for a pregnant woman with one prior transverse uterine incision have "important risks and benefits and that the risks and benefits differ for the woman and her fetus." The NIH's conclusion on the topic, as explained in the paper, is that when both methods (TOLAC versus repeat cesarean) are equivalent as options, a woman and her doctor should share in making the final decision, and whenever possible, honor the woman's choice.
According to the APA, the highest rate of VBAC involves women who have experienced both vaginal and cesarean births and who, after having been given the choice, have decided to give birth vaginally. The key thing to note, however, is that not everyone is the best candidate for a VBAC. VBAC eligibility depends on many factors. The Mayo Clinic explains many of these factors in detail on its website. Those with the best eligibility include women who have had at least one vaginal delivery before or after a prior C-section, women who have had low transverse incisions from their prior C-section, and women whose C-sections were performed for a reason that is not present during their current pregnancy.
Those who may not be the best candidates for VBAC, as outlined on the Mayo Clinic's website, should consider whether or not they've had a vertical incision in the upper part of the uterus, as they could run the risk of a uterine rupture during the VBAC. You may also risk uterine rupture if you attempt VBAC too soon after having a C-section (e.g. 18-24 months). Other things to factor in include whether you've had multiple C-sections, health concerns that might affect a vaginal delivery, if you plan to deliver at home, and if you need to be induced. Those who experienced a uterine rupture during a previous pregnancy are not candidates for VBAC, either.
If your head is dizzy from all these factoids, here's the breakdown: As long as you are deemed an appropriate candidate for a VBAC, there's a good chance you'll succeed. Your chances of success are even higher if your reasons for your previous C-section are not present in your current pregnancy. And as the website, Baby Center points out, you'll need to deliver in a hospital that allows VBACs and where they are staffed appropriately for such procedures.
Whether to attempt a VBAC or to schedule a repeat C-section is a very personal decision. It is important to weigh the benefits and risks of each with a healthcare provider you trust, taking into account the specifics of your past deliveries, current pregnancy and health, and your future reproductive goals.