ACOG Practice Bulletin No. 184: Vaginal Birth After Cesarean Delivery

(Replaces Practice Bulletin Number 115, August 2010)

Trial of labor after cesarean delivery (TOLAC) refers to a planned attempt to deliver vaginally by a woman who
has had a previous cesarean delivery, regardless of the outcome. This method provides women who desire a vaginal
delivery the possibility of achieving that goal—a vaginal birth after cesarean delivery (VBAC). In addition to fulfilling
a patient’s preference for vaginal delivery, at an individual level, VBAC is associated with decreased maternal
morbidity and a decreased risk of complications in future pregnancies as well as a decrease in the overall cesarean
delivery rate at the population level (1–3). However, although TOLAC is appropriate for many women, several factors
increase the likelihood of a failed trial of labor, which in turn is associated with increased maternal and perinatal
morbidity when compared with a successful trial of labor (ie, VBAC) and elective repeat cesarean delivery (4–6).
Therefore, assessing the likelihood of VBAC as well as the individual risks is important when determining who is an
appropriate candidate for TOLAC. Thus, the purpose of this document is to review the risks and benefits of TOLAC
in various clinical situations and to provide practical guidelines for counseling and management of patients who will
attempt to give birth vaginally after a previous cesarean delivery.

Reference: Practice Bulletin No. 184: Vaginal Birth After Cesarean Delivery. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;130:e217–233.