Definition of VBAC and TOLAC

What do the terms VBAC and TOLAC mean in pregnancy?

A mother holding her newborn baby in the hospital.
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There are a lot of terms and acronyms that get thrown around in the medical field, and pregnancy and prenatal care are no different. When you go to look at your prenatal care chart or your medical records, particularly, you may feel like you are trying to read a different language. The terms used are meant to be standardized terms so that any doctor or midwife who picked up your chart would understand what medical care you received, and what your medical and health history was.

This can be extra complicated if you have had a prior baby born via c-section.

Once you have had a cesarean surgery to give birth to a baby, your medical record will need to indicate this for a variety of reasons. This first reason is that you now have a scar on your uterus. While this is not the only reason to have a scar on your uterus, it is one of the more common reasons. Your medical history should also note the reason that you had a c-section. For example, some reasons are things that were specific to that pregnancy or baby and are not likely to repeat themselves, such as fetal distress due to an induction or even a breech baby. Other reasons for a c-section may be more likely to happen again. This can help you and your doctor or midwife to plan for your next pregnancy and birth.

The vast majority of women who have had a prior c-section are good candidates for having a vaginal birth in subsequent pregnancies.

This is known as a vaginal birth after cesarean or VBAC. Some practitioners will spend a lot of time talking about how labor will go in this new pregnancy, offering what is often called a trial of labor after a cesarean or the acronym TOLAC. This refers to attempted labor during a vaginal birth after cesarean (VBAC).

Supporters of VBAC say that this terminology is negative minded and encourage women to think about the likelihood of success.

The American College of Obstetricians and Gynecologists (ACOG) believe that VBAC is a safe option for most women, even if they have had two prior cesareans with a certain type of incision. This is where your medical records can come in handy to show any potential new practitioners what type of incision was used in your prior cesarean births. 

Regardless of what you call it, VBAC or TOLAC, having a vaginal birth can have benefits for the mother and baby. Be sure to talk to your doctor or midwife about the risks and benefits for your situation. Do not hesitate to get a second opinion, this can be a big decision and not all practitioners believe that VBAC should be offered despite its proven benefits in a population based view.

Sources:

Landon MB, Hauth JC, Leveno KJ, Spong CY, Leindecker S, Varner MW, et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. N Engl J Med 2004;351:2581–9.

National Institutes of Health. NIH Consensus Development Conference: vaginal birth after cesarean: new insights. Consensus Development Conference statement. Bethesda (MD): NIH; 2010.

Vaginal birth after previous cesarean delivery. Practice Bulletin No. 115. American College of Obstetricians and Gynecologists. Obstet Gynecol 2010;116:450–63.

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