Vaginal Birth After Cesarean Section
(VBAC; Trial of Labor after Cesarean [TOLAC])
by Cynthia M. Johnson, MA
Vaginal birth after cesarean section (VBAC) is giving birth vaginally after having a baby in an earlier pregnancy by cesarean section (C-section).
Reasons for Procedure
The goal of this procedure is to give birth vaginally, rather than through an elective C-section. Many women who have had a C-section in the past can deliver future babies vaginally with a low risk of complications.
Problems are rare, but all procedures have some risk. The doctor will go over some problems that could happen, such as:
Things that may raise the risk of problems are:
What to Expect
Prior to Procedure
During pregnancy, the mother should:
True Versus False Labor
There may be periods of false labor before true labor begins. These are irregular contractions of the uterus, called Braxton Hicks contractions. They are normal, but can be painful. Timing the contractions is a good way to tell the true and false labor apart. Note how long it is from the start of one contraction to the start of the next one. Keep a record for an hour. If the contractions are getting closer together, longer, and stronger, then it may be true labor. Call the doctor.
The uterus will start to contract at the beginning of labor. This will move the baby down the vagina (birth canal). The opening (cervix) of the uterus into the vagina will slowly enlarge to a diameter of about 10 centimeters. This will allow the baby to pass through and be delivered through the opening of the vagina.
Labor can cause severe pain. In the beginning stages of labor, relaxation methods like meditation and rhythmic breathing may be helpful. Keep in mind that every mother's labor is different and everyone feels pain differently.
There are many options for pain control. The doctor may give:
Description of Procedure
After the cervix is fully dilated (opened) and the baby seems to be heading down the birth canal, the care team will help prepare you for delivery. Your legs may be draped with cloths. The area around the vagina will be cleaned with an antiseptic solution.
You may put your legs into holders, especially if you have an epidural. The care team may hold your legs in a position. This will help you to push. You may be asked to find a position that is right for you. You will be asked to push each time you have a contraction. This involves bearing down like you are trying to have a bowel movement.
Crowning is when the baby's head is seen at the opening to the vagina. When this happens, you may be asked to slow your pushing. Depending on your delivery plan, the doctor may massage your perineum to gently stretch it. Some people may need an episiotomy, but it is not routine.
You will be asked to stop pushing when your baby's head is out. The doctor will check to make sure that the umbilical cord is not around the baby's neck. Then, you will be able to push the rest of the baby out. If the baby appears healthy and is breathing well, your baby may be placed on your stomach. The umbilical cord will be clamped and cut. Within the next 20 minutes, the placenta will be delivered.
Sometimes the baby's head does not move as expected through the birth canal. If this happens, the doctor may use forceps or vacuum extraction to move the baby. These will only be used if the baby is most of the way through the birth canal.
Immediately After Procedure
You may have the following:
How Long Will It Take?
How long it takes varies from person to person. The average time to deliver a first baby vaginally is 12 hours.
Will It Hurt?
Pain and swelling are common in the first few days. Medicine and home care help.
Average Hospital Stay
Most people can go home in 1 to 3 days. If there are any problems, you may need to stay longer.
Having a baby will change you physically and emotionally.
Physically, you might have the following:
Emotionally, you may be feeling:
Ways to Take Care of Yourself
Here are tips to take care of yourself:
Call Your Doctor
Call the doctor if you are not getting better or you have:
If you think you have an emergency, call for medical help right away.
Family Doctor—American Academy of Family Physicians
Women's Health—US Department of Health and Human Services
Women's Health Matters
ACOG Practice bulletin no. 115: Vaginal birth after previous cesarean delivery. Obstet Gynecol. 2010;116(2 Pt 1):450-463. doi:10.1097/AOG.0b013e3181eeb251.
Trial of labor after Cesarean section (TOLAC). EBSCO DynaMed website. Available at: https://www.dynamed.com/management/trial-of-labor-after-cesarean-section-tolac. Accessed August 27, 2021.
Vaginal birth after Cesarean delivery. The American Congress of Obstetricians and Gynecologists website. Available at: https://www.acog.org/womens-health/faqs/vaginal-birth-after-cesarean-delivery. Accessed August 27, 2021.
Last reviewed July 2021 by EBSCO Medical Review BoardBeverly Siegal, MD, FACOG
Last Updated: 8/27/2021
EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.
This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.
To send comments or feedback to our Editorial Team regarding the content please email us at firstname.lastname@example.org. Our Health Library Support team will respond to your email request within 2 business days.
All rights reserved.