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VBAC - How Do I Decide???

childbirth vbac May 22, 2021


Curious about your birthing options after having had a previous cesarean section?

We have you covered! For most women, you can either elect to have another cesarean section or you can opt for a Trial of Labor After Cesarean Section (aka TOLAC) in hopes of having a Vaginal Birth After Cesarean Section (aka VBAC). 

Below you will find a quick summary of our podcast where Drs. Sarah and Alicia discuss the benefits and risks of TOLACs and VBACs.  But, please subscribe and listen to the podcast below to hear all the juicy details! 

So, you may be wondering, who would make a good candidate for a TOLAC? In general, you would be a good candidate for a TOLAC if you had a previous cesarean section for the following reasons: 

  1. Baby’s position (i.e. breech position or if your baby was looking up, as opposed to down to the ground) 
  2. Poor placental position (i.e. if the placenta was lying over the cervix) 
  3. Distressing fetal heart rate (too fast or too slow)
  4. Your first baby was large, but this baby is small(er)! 


Now, unfortunately, there are a few risk factors that would NOT make you an ideal candidate for a TOLAC. These include having had the following risk factors: 

  1. 2 or more cesarean sections. Due to the multiple surgical scars, there is a much higher risk of uterine tearing which compromises the blood flow to the baby. 
  2. A previous slow or stalled labour. This could be a sign that the baby may have been too big to fit through your pelvis.  
  3. A previous uterine surgery (i.e. removal of fibroids). Again, having multiple surgeries on your pelvis increases your risk of uterine rupture.  
  4. A large baby in the current pregnancy
  5. Increased BMI 
  6. Previously gone into labour after your due date 
  7. Having had a previous “classical” cesarean section.  This occurs when the surgeon places a vertical incision in your abdomen, as opposed to a horizontal incision. This is an absolute contraindication for a VBAC. Don’t fret, most cesarean sections are done with a horizontal incision!


Now, as with anything, there are some risks involved with a TOLAC. There is an increased risk of:

  1. uterine rupture which reduces blood flow to the baby
  2. requiring an emergency cesarean section
  3. infection
  4. bleeding
  5. some newborn complications

Therefore, if you do decide to have a TOLAC, we want you to tell us when you go into labour. Due to some of the increased risks, we don’t want you to labour at home. We will request that you come into the hospital a bit earlier than usual! 

So now that you have heard of the risks of a TOLAC, you may be wondering about the benefits of a VBAC. There are three main reasons why having a VBAC may be the right decision for you! These include the following:

  1. If you are planning on having 3 or more babies. Having more than 2 cesarean sections puts you at higher risk for surgical complications.  Therefore, if you are hoping to have 3 or more kiddos, we would suggest you consider having a TOLAC and VBAC. 
  2. If you want to experience a vaginal birth. Maybe you do! Maybe you don’t! This is a personal preference. 
  3. If you want to avoid having surgery. This may be due to your current health or because you wish to have a shorter recovery time after giving birth. Recovery times with vaginal deliveries are often shorter than those who have had a cesarean section. 

Again, this is a personal decision and it is dependent on many factors. Please talk to your care provider about your own experiences and future wishes in order to come to the best decision for YOU.  In particular, we want to know why you had a cesarean section previously and we want to help you to come to the best decision for you and your baby!  

Have a listen to our podcast to get more info!! 

Oliva, Medical Student



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