Vaginal Birth After Cesarean
American College of Obstetricians and Gynecologists
From 60 to 80% of women who attempt a trial of labor after cesarean delivery (TOLAC) achieve a successful vaginal birth.
Conditions that can make VBAC less likely if TOLAC is attempted include advanced maternal age, a high body mass index, a high birth weight, and a previous [cesarean delivery] that resulted because the cervix failed to dilate.
Recommend that TOLAC be attempted in facilities that can provide cesarean delivery for situations that are immediate threats to the life of the woman or fetus.
Women undergoing TOLAC should not attempt to deliver at home.
Several advantages associated with VBAC include allowing women to avoid major abdominal surgery and lowering their risk for hemorrhage, blood clots, and infection. It also shortens the recovery period and reduces women's risk for experiencing maternal morbidity or mortality during delivery in a future pregnancy as a result of repeated cesarean deliveries.
The number of previous cesarean deliveries, the reasons for them, and the types of surgical incisions used should all be considered when making decisions regarding VBAC and TOLAC.
Most women with one previous cesarean delivery with a low-transverse incision are safe candidates for TOLAC.
Planned TOLAC is generally not recommended for women with high risk for uterine rupture and women in whom vaginal delivery is contraindicated, such as those with placenta previa.
Do not use misoprostol for cervical ripening or labor induction in term patients with prior cesarean delivery or major uterine surgery. Epidural analgesia for labor may be used during TOLAC.
Women with one previous cesarean delivery with a low-transverse incision, who are otherwise appropriate candidates for twin vaginal delivery, are considered candidates for TOLAC.
Induction of labor remains an option in women undergoing TOLAC.
External cephalic version of infants with breech presentation is not contraindicated in women with a prior low transverse uterine incision who are candidates for external cephalic version and TOLAC. These women should undergo continuous fetal heart rate monitoring during TOL.
References
Brown T. Updated Guidelines on VBAC Released by ACOG. Medscape News. WebMD Inc. November 7, 2017. https://www.medscape.com/viewarticle/888126
Practice Bulletin No. 184: Vaginal Birth After Cesarean Delivery. Committee on Practice Bulletins-Obstetrics. Obstet Gynecol. 2017 Nov;130(5):e217-e233. https://insights.ovid.com/pubmed?pmid=29064970
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: John Anello, Brian Feinberg, John Heinegg, et. al. New Clinical Practice Guidelines, December 2017 - Medscape - Dec 06, 2017.
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