What is the Difference Between VBAC and TOLAC?
What is the Difference Between VBAC and TOLAC? When Do You Recommend One Over the Other?
I get lots of questions from women who’ve had a previous cesarean section: whether or not they should have a repeat cesarean section or if they’d be a reasonable candidate for trying for a vaginal birth. In this situation we call it a VBAC, vaginal birth after cesarean section, or a TOLAC, trial of labor after cesarean section.
It is a very personal choice and women will choose different things depending on their circumstances. I really encourage women to discuss it with their doctor who can look at their records and know their risk factors and really review what their last experience was and see what their personal preference is.
Excellent candidates for a VBAC or TOLAC are patients who have had a low-risk pregnancy and patients who have had what we call a “non-repeating cause” of their c-section. These women perhaps had a breach delivery the first go around and had to have a c-section for that reason or perhaps a baby or fetus that had a cord wrapped its neck, causing fetal distress in labor, and had a c-section for that reason. Again, it’s an unlikely event to repeat itself the second go around.
If a woman, for example, had trouble getting the baby out of the pelvis, that would be a failure to progress situation, which is more likely to come up a second time, so it involves a little different decision making between the patient and the provider.
When women ask me these questions, I like to pull up a calculator, which are available online, and we put in together the risk factors of what happened with the first labor and delivery, whether or not they’ve had any vaginal births, and what their medical complications are and we can know what their chances are of having a successful vaginal birth if we try for that TOLAC.
Women make different decisions, and it really comes down to what their first experience was all about. For women who had a really long, hard labor followed by an emergency c-section, even when they are excellent VBAC candidates, they feel really reluctant to repeat that experience and a lot of them will elect to have a repeat cesarean because they are a bit traumatized from their first experience and I think that is something we should really look at and support.
I feel like some women who might not be ideal candidates are really motivated to at least try for a vaginal birth and I’m also very supportive of that. Sometimes women had a hard recovery after a c-section, and they really want to avoid a repeat c-section if they can. They also might simply want a larger family and they know that 6 or 7 c-sections are not the best health choice for them so they might be motivated to try for a vaginal birth as well.
That said we always go through all the risks and benefits in detail. We try to make a safe and shared decision together and I really like to support women in what they ultimately decide to do.