If you had a C-section and you are pregnant again, you may want to have a vaginal birth this time. There is a good chance that you can. Because doctors love acronyms, a vaginal birth after C-section is called a VBAC. The process of attempting a vaginal birth is called a trial of labor after cesarean. Here’s the acronym: TOLAC. [1-3]
You have options. You may choose to have another C-section. You may choose TOLAC and VBAC. As with any medical decision, there is a balance of risks and benefits to consider. You should discuss these with your obstetrical care provider. After reading this, you will have the information you need to start the discussion. [1-3]
Are You a Good Candidate for TOLAC?
There are a few reasons not to try TOLAC. The main complication of VBAC is tearing (rupture) of your uterus during delivery. This is a serious complication that can cause heavy bleeding and damage to your baby. If you had a tear during a previous C-section, TOLAC is not advised. [1-3]
The type of incision is another reason. If you had a low side-to-side incision (low transverse), chances of uterine rupture are lower than if you had an up and down incision (high vertical). If you had the high vertical incision, TOLAC is not advised. [1-3]
The number of C-sections you have had is also important. If you have had two or more, your doctor may advise against TOLAC. Finally, you need to deliver at a hospital that offers TOLAC. These hospitals are equipped to monitor TOLAC and to perform an emergency C-section if necessary. If you are not near a facility that offers TOLAC, VBAC may not be an option for you. 
Why Consider VBAC?
About 80 percent of women are candidates for TOLAC. For these women, VBAC is successful in about three out of four cases.  Your odds are good. If TOLAC works, you avoid abdominal surgery. This may increase your chances for more successful vaginal births in the future. [1-3]
Women who have multiple C-sections are at higher risk for surgical complications – including emergency hysterectomy – that may end the possibility of future pregnancies. Here are some other reasons to consider VBAC: [1-3]
- Shorter and less painful recovery time
- The experience and participation of vaginal birth
- Lower cost
- Lower risk of infection and blood loss
Your chances for successful VBAC go up if you have only had one C-section, and if you have had a successful vaginal delivery in the past.  Your chances improve if your pregnancy is healthy and if labor begins on or before your due date. [1-3]
What Are the Risks of VBAC?
The big risk is uterine rupture. If your provider says you are a candidate for VBAC, this risk is low. Uterine rupture only occurs in about 1 in 500 VBAC candidates.  If a rupture does occur, there is risk to you from heavy bleeding and infection. Uterine rupture may require an emergency hysterectomy. There is a chance your baby will be harmed. Even though the risk is low, you need to weight it against the benefits. [1-3]
The other risk is less dangerous. You may go through TOLAC and still need a C-section. This may happen if: [1,3]
- You go beyond your due date.
- Labor needs to be induced.
- You have a large baby.
- You have a breach birth.
- Your baby has fetal distress during labor.
Now that you know the basics, you can have a discussion about TOLAC and VBAC with your obstetrical care provider. If your provider thinks you are a good candidate for VBAC, and you want to give it a try, your chances are good. [1-3] Some recent studies suggest that VBAC may be safer than a repeat C-section for women who are good candidates.  Talk to your provider about your risks and benefits.
- American Pregnancy Association, VBAC: Vaginal Birth After Cesarean.
- Mayo Clinic, Vaginal birth after C-Sections (VBAC).