What is TOLAC? Pros and Cons of Trial of Labor After Cesarean

Discussing TOLAC with an ob-gyn

​When discussing the options available for women who have had a previous C-section and desire a vaginal birth, two terms commonly come up: VBAC (Vaginal Birth After Cesarean) and TOLAC (Trial of Labor After Cesarean).

​While both terms refer to attempting a vaginal birth after a previous C-section, there is a subtle distinction between the two. In this blog post, we will explore what TOLAC entails, its potential benefits, risks ​and factors to consider when making a decision about this option ...

What is TOLAC in pregnancy?
VBAC, as the name suggests, refers to the actual successful vaginal birth after a previous C-section. It implies that the woman has undergone labor and successfully delivered the baby vaginally. On the other hand, TOLAC encompasses the entire process of attempting a vaginal birth, including the trial of labor itself, whether it leads to a successful vaginal birth or results in a repeat C-section.
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In essence, VBAC is the desired outcome, while TOLAC is the process or attempt to achieve that outcome. TOLAC acknowledges the possibility that a woman's labor may not progress as desired or other circumstances may arise, leading to a repeat C-section. It encompasses both the potential for a successful vaginal birth and the possibility of a planned or unplanned repeat C-section.

Benefits of TOLAC
1. Vaginal Birth Experience: Many women who have had a C-section in the past express a desire to experience a vaginal birth. TOLAC provides an opportunity for such women to fulfill this desire while ensuring a safe and healthy delivery.
2. Reduced Risks of Surgical Complications: Vaginal birth generally carries fewer risks and complications compared to a repeat C-section. TOLAC can potentially minimize the risks associated with surgery, such as infections, blood loss, and blood clots.
3. Shorter Recovery Time: Recovering from a vaginal birth is generally faster and less physically demanding than recovering from a C-section. By opting for TOLAC, women may experience a shorter hospital stay and quicker postpartum recovery.

Risks and Considerations

1. Uterine Rupture: The most significant concern associated with TOLAC is the risk of uterine rupture. Although rare, uterine rupture can be a life-threatening complication where the surgical scar on the uterus from the previous C-section tears during labor. The risk of uterine rupture is estimated to be around 0.5% to 1%, and immediate medical intervention is required if it occurs.
2. Failed Trial of Labor: TOLAC may not always result in a successful vaginal birth. Factors such as the size and position of the baby, maternal health conditions, or labor progression can lead to a failed trial of labor. In such cases, an emergency C-section may become necessary.
3. Availability of Emergency Care: It is crucial to ensure that the healthcare facility where TOLAC is being attempted is well-equipped to handle any potential emergencies. Access to skilled medical professionals, anesthesiologists, and operating rooms should be readily available to ensure prompt intervention if needed.

Factors to Consider
1.   Previous C-Section Incision Type: The type of incision from the previous C-section can influence the feasibility of TOLAC. Low transverse incisions have a lower risk of uterine rupture compared to vertical incisions, making them more suitable for TOLAC.
2. Indication for Previous C-Section: Understanding why the initial C-section was performed is essential. Some indications, such as fetal distress or breech presentation, may not necessarily impact the feasibility of TOLAC, while others, such as placenta previa or certain uterine conditions, may increase the risks.
3. Maternal Preference and Emotional Considerations: A woman's personal preference and emotional well-being play a significant role in the decision-making process. Open communication with healthcare providers, discussing fears, concerns, and expectations can help in making an informed choice.

Conclusion
TOLAC, or Trial of Labor After Cesarean, offers women who have had a previous C-section the opportunity to attempt a vaginal birth for subsequent pregnancies. It can provide a range of benefits, including a vaginal birth experience, reduced risks of surgical complications, and shorter recovery times. However, it is crucial to consider the potential risks, such as uterine rupture, and the availability of emergency care. Factors like the type of previous incision and the reason for the initial C-section should also be taken into account when deciding whether TOLAC is the right choice. Ultimately, the decision should be made in consultation with healthcare providers, taking into consideration the individual circumstances and preferences of the woman.
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Are you looking into a TOLAC / desiring a VBAC? I’m a certified VBAC Doula (see www.vbac-link.com) and would be more than happy to support you. If needed, I can also help with finding the suitable healthcare providers in the area of Washington DC, Maryland and Northern Virginia that have a strong track record in VBACs.