Delivery after previous caesarean section

In case of a previous caesarean section a subsequent pregnancy can be planned to be delivered by either of the following two main methods:

• Vaginal birth after caesarean section (VBAC)
• Elective repeat caesarean section (ERCS)

Both have higher risks than a vaginal birth with no previous caesarean section. There are many issues which affect the decision for planned vaginal or planned abdominal delivery. There is a slightly higher risk for uterine rupture and perinatal death of the child with VBAC than ERCS, but the absolute increased risk of these complications is small, especially with only one previous low transverse caesarean section. A large majority of women planning VBAC will achieve a successful vaginal delivery, although there are more risks to the mother and baby from an unplanned caesarean section than from an ERCS. Successful VBAC also reduces the risk of complications in future pregnancies more than ERCS.

In 2010, the National Institutes of Health, U.S. Department of Health and Human Services, and American Congress of Obstetrics and Gynecology all released statements in support of increasing VBAC access and rates. Recently, it is recognized that as the number of cesarean sections a patient undergoes increases so does the risk of significant obstetrical complications It is still suggested to try VBAC over ERCS even with its slightly higher risk of uterine rupture.

TOLAC (trial of labor after caesarean) is an attempt at vaginal delivery to see whether it can succeed in resulting in a VBAC. If it turns out not to progress acceptably, then a caesarean is performed.