Preparing For TOLAC and VBAC Birth: Facts, Risks, and Tips! (Explained by an L&D nurse)

Hi Mama! Today I’m going to discuss preparing for a TOLAC or VBAC birth! What is a VBAC, you ask? What is a TOLAC?

  • VBAC: Vaginal Birth After Cesarean
  • TOLAC: Trial of Labor After Cesarean

Basically, VBACs and TOLACs are when you’ve had one (or more) C-sections in the past and you’re attempting to deliver your NEXT baby vaginally!

Technically speaking, anyone PLANNING for a VBAC is really doing a TOLAC. If the labor results in a successful vaginal birth you had a VBAC! Are you following me there?

But really, the two terms are used pretty interchangeably. And the acronym VBAC is definitely more well known and used. We have a TON of VBACs at the hospital I work at. I would describe us as VERY VBAC friendly!

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Preparing for a TOLAC or VBAC: Why should I have a VBAC?

The benefits of a vaginal delivery outweigh ANOTHER Cesarean delivery more times than not. No surgical interventions, a shorter hospital stay, and a speedy postpartum recovery are just a few benefits.

It’s also important to think about the future…If you’re considering having more children, having a VBAC will help you avoid the risks of multiple Cesarean deliveries such as problems with your placenta!

Related: C-Section vs Vaginal Birth: Pros and Cons

Some VBAC facts

In 2016, the C-section rate in the United States topped out at a whopping 31.9%. You guys, that’s almost one-third of ALL births.

Some C-sections are warranted (MANY of them are warranted), but there are still providers who do them for unnecessary reasons (convenience being the #1 reason).

That’s pretty darn high…BUT, do you know one way to decrease this statistic?

Become informed about TOLAC and VBAC! I come into contact with many women who have NO IDEA that you can have a vaginal delivery after you have a C-section – and really that’s just not okay.

 

In fact, 90% of women who have had a previous C-section are candidates for a VBAC delivery.

That’s right, you heard me, NINETY PERCENT.

Okay, but let’s go over that 90%…

First of all, just because you are a candidate for a VBAC, DOES NOT mean you need to (or should) have one!

Before we go into more of the goodness that VBAC’s can bring, let’s talk about RISKS real quick…(because just like ANYTHING, there are risks with TOLAC too!)

VBAC risks

UTERINE RUPTURE. That’s the biggie.

A uterine rupture is super scary and can be life-threatening to mom and baby.  During a uterine rupture, the uterus tears open, and you’ll need to have an emergency Cesarean section.

Very rarely do they actually happen (less than 1 percent of women who choose to VBAC), but they do happen, and your provider will explain this to you when you come into the hospital to labor.

uterine rupture infographic

Very, very rarely your uterus may have to be removed (a hysterectomy) if you experience a uterine rupture. This typically happens if your bleeding is poorly controlled during surgical intervention, and it’s usually done pretty quickly, to save your life.

Obviously, if your uterus is removed, you will no longer be able to become pregnant. I know that’s harsh to say, but those are the risks! Very, very small likelihood, but risks that do need to be considered.

Related: How to Prevent Tearing During Delivery

Related: Tearing vs. Episiotomy

Are you eligible for a VBAC?

want to vbac infographic

There’s a fancy VBAC calculator that your provider will use to determine your VBAC success rate!

Basically, you enter your demographics, previous info about your C-section(s), current cervical check, and medical history…and BAM, the fancy VBAC calculator gives you an evidenced-based percentage of being able to successfully deliver your baby vaginally.

Pretty cool!

***Here’s the VBAC Calculator ACOG uses!***

Who can’t TOLAC?

But see, even if you only have a 15% chance of delivering vaginally according to the VBAC calculator, you still fall within that 90% (that’s why it’s so high).

Who are the 10% of women who CANNOT VBAC? Good question.

  • If you’ve ever had a uterine rupture
  • If you had a classical incision for your previous C-section. A classical incision is an incision that is vertical on your uterus, instead of low & horizontal. It carries a MUCH higher risk of having a uterine rupture, which is why you won’t be able to TOLAC
  • Other normal reasons for considering C-section instead of vaginal birth (whether you’ve had a C-section before or not) like placenta previa, baby’s positioning, baby’s tolerance of labor

Learn more about preparing for a scheduled C-section!

Deciding to TOLAC

Alright, so once your provider has determined your success rate, now it’s decision time.

It’s YOUR decision whether you want to take the percentage that your provider has given you and attempt a TOLAC/VBAC…and it’s also your PROVIDER’s choice as to whether they will support you in your decision to VBAC.

There are MANY providers who are not so comfortable with VBAC’s, so RULE NUMBER ONE:

If you’re pregnant and interested in attempting a VBAC…find a willing and skilled provider!

This is soooo important to a successful vaginal delivery. Many providers (and hospitals) nowadays will deny a mom a VBAC, so it’s important to do some research around your area.

Interview your provider, ask him/her questions about the success rates, the guidelines of the hospital, and how a typical VBAC is run…

Will they allow you to be induced? Or will they only support your VBAC if you’re already in labor yourself? (This is a big factor that changes the VBAC calculator)

how to choose a pregnancy provider infographic

A few other questions to ask your provider about VBAC’s:

  1. How long will I be given to successfully VBAC?
  2. What is your (and your hospital’s) success rate?
  3. How does your on-call schedule work? If YOU are unavailable during my delivery day…will your colleagues support my decision to VBAC? What are THEIR success rates?

As you can see…VBAC’s can become very complicated. And they totally shouldn’t be!

OKAY, LET’S GET TO THE REASON WHY YOU PROBABLY CLICKED ON THIS ARTICLE!

How do I increase my TOLAC success rate?

Yes, you heard me! There are many things you can do to INCREASE the likelihood that you’ll deliver vaginally! Woohoo!

1. Become informed

I’ve already highlighted one of them…become informed! The more INFORMED you are about successfully VBACing, the MORE likely you are to succeed in your goal!

2. Go into labor spontaneously

Go into labor on your own, and avoid being induced. This is a biggie. Successful VBAC’s do happen when they are induced, but it’s MUCH more likely to happen if your body is already taking the necessary steps!

done being pregnant meme, funny third trimester meme, funny due date meme

3. Avoid an epidural or wait as long as possible to get one

TRY YOUR BEST to either deliver without an epidural or wait as long as you possibly can before receiving one. IDEALLY when you’ve hit the active labor stage (around 6 centimeters).

best time to get an epidural infographic

4. Hire a doula

Research has proven that hiring a doula during your labor significantly reduces your likelihood of requiring a C-section! Learn more about doulas and how to find one in your area here!

more calming hospital birth experience infographic

Why going without an epidural can REALLY up your VBAC success

It’s hard, I know. I delivered my son without an epidural, and girl I feel you. Those labor contractions are NO JOKE.

The truth is, your provider may tell you that epidurals bear no weight on whether you’ll end up with a C-section…

There are a TON of evidenced-based articles out there saying so….I GET IT!

I’m just trying to explain to you what I’ve seen in the delivery room, time and time again…

What I’ve seen in the labor and delivery room when mamas get epidurals:

  • Patient gets epidural
  • Contractions slow down
  • Pitocin is started
  • Baby starts to NOT like Pitocin
  • Pitocin stopped/slowed
  • Contraction pattern gets weird
  • Patient stops dilating. Hours go by
  • Patient ruled “failure to progress”
  • C-section

OR

  • Patient gets epidural
  • Baby gets in a funky position in pelvis
  • Mom is confined to bed because of epidural
  • Baby stuck in weird position, without mom’s free movement during labor
  • Mom pushes for hours
  • Baby doesn’t descend because he’s in that weird position
  • Patient ruled “failure to descend”
  • C-section

There are also many outcomes where patients end up getting epidurals and they do totally fine! I’ve seen it both ways.

WHAT I DON’T SEE TOO OFTEN….A natural VBAC-er getting a C-section! It’s a very personal choice, but I encourage you to try and labor as long as you can naturally! This will really help your odds of a successful TOLAC!

If you are interested in learning more about birthing without an epidural and want to prepare for this goal a birth course will really make all the difference!

Check out my natural birth course, it’s helped thousands of mamas just like you!

Mama, you’ve got this TOLAC!

There you have it! Planning a TOLAC or VBAC? I’d love to hear from you!! Comment below so I know where all my lovely VBAC mommies are!

Have any more tips? Let me know! I’d be happy to add to this article!

***Update***

Here’s a quick little video I found talking about VBAC’s if you’re interested!

https://www.youtube.com/watch?v=DXWe_yrTeEg

Happy VBACing!

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Liesel Teen, BSN-RN
Founder, Mommy Labor Nurse

Meet Liesel Teen

Hi there. I’m Liesel!

As a labor and delivery nurse, I’ve spent countless hours with women who felt anxious — even fearful — about giving birth. I want you to know it doesn’t have to be that way for you!

When you know what to expect and have the tools to navigate the experience, you’ll feel confident and in control.

I believe you deserve a better birth — no matter how you deliver.