Glossary

Term · Postpartum: Your Body

trial of labor after cesarean

Also: TOLAC, trial of labor, labor after a cesarean

An attempt at vaginal birth after a previous cesarean. Eligibility depends mostly on the type of uterine incision from the earlier surgery.

In plain words

A trial of labor after cesarean, often shortened to TOLAC, is a labor that is allowed to go on for a woman who had a before. The goal is a vaginal birth. Whether it is offered depends on the kind of cut the surgeon made in the uterus, which is written in the operative note. Most women with a low, side-to-side incision are eligible. A trial can end in a planned or unplanned cesarean, and that is part of the plan. A trial is not the same as a , which is the outcome, and it is not the same as an . Providers talk through the risks with each mother before she decides.

The deeper version

ACOG Practice Bulletin 205 (2019) states that women with one prior low transverse cesarean and no contraindication are candidates for TOLAC; classical and T-shaped incisions, which extend into the contractile upper segment, carry a higher risk of uterine rupture and are generally excluded. Rupture rates in TOLAC are roughly 0.5 to 1 percent overall, with higher rates in women who were induced or augmented (Landon 2004, NEJM, the MFMU Network cohort of about 18,000 women who labored). Success rates are roughly 60 to 80 percent across studies. Controversy continues over induction and augmentation in TOLAC and over whether elective repeat cesarean should be offered as the default; ACOG and RCOG (Green-top 45, 2015) differ in emphasis.

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Sources

  • American College of Obstetricians and Gynecologists — Practice Bulletin 205: Vaginal Birth After Cesarean Delivery, 2019
  • Landon MB et al. for the NICHD MFMU Network — Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. New England Journal of Medicine 2004
  • Royal College of Obstetricians and Gynaecologists — Green-top Guideline 45: Birth After Previous Caesarean Birth, 2015

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