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If you’ve had a C-section before and are pregnant again, chances are you have been thinking about what your delivery will look like this time around. The good news is that your options are still open—but you should be aware of what your choices are so you and your provider can make an informed decision. Here are some common questions many moms have regarding delivery after a C-section.

I’ve had a C-section before. Do I need to have another one?

The short answer: no! The American College of Obstetrics and Gynecology issued a statement saying that women who have had one or two previous C-sections are candidates for a “trial of labor after cesarean,” or TOLAC. This means you can attempt to labor naturally after a cesarean in most cases. However, it only applies to women whose C-section incision was on the lower segment of the uterus. You can’t determine this by the scar on your abdomen, but your provider can get this information from your health record.

If I want a TOLAC, what are my risks?

The greatest risk of laboring after a C-section is uterine rupture, and luckily this is very rare (less than 1 percent, though this may be slightly higher in women with two prior C-sections). A uterine rupture occurs when the previous C-section incision opens. It can lead to internal bleeding, fetal distress, need for an emergency C-section, and potentially harm or death to the mother or baby, but this is exceedingly rare. Another risk is that a mother will attempt a vaginal delivery but will still need a repeat C-section.

Are there risks to a repeat C-section?

Any surgery is associated with risk, and a C-section is no different. Compared to vaginal birth, C-sections are associated with higher rates of blood loss, infection, injury to internal organs, need for blood transfusion, blood clots, and need for hysterectomy. Healing time is also longer. Additionally, the more C-sections a woman has, the higher the chances are that there will be issues with where and how the placenta attaches in future pregnancies.

Do all providers offer TOLAC?

No. A TOLAC should only be offered when there is the ability to perform an immediate C-section should a complication arise. Smaller hospitals may not always be able to accommodate this. Some obstetric providers do not offer TOLAC for legal reasons. In this case, if a woman desires a trial of labor, she should be referred to a provider who would be able to offer this to her.

If I opt for a repeat C-section, when is it scheduled?

It should not be scheduled any sooner than 39 weeks’ gestation unless there is a medical reason for an earlier delivery or labor starts before your scheduled date.

Reviewed by Dr. Jen Lincoln, December 2018

Takeaways

  • If you’ve had one or two C-sections before, you may be a candidate for a trial of labor after cesarian (TOLAC).
  • A C-section is not risk-free, and healing time is definitely longer than with a vaginal birth.
  • If you want a TOLAC and your provider does not offer them, ask about a referral to someone who will.

References

  1. American College of Obstetrics/Gynecology Practice Bulletin. Vaginal Birth After Previous Cesarean Delivery.

Comments

  1. I wanted to try for a vaginal delivery with my second child (I delivered my first via c section). Unfortunately, this wasn’t an option for me. After having 2 c sections, I am nervous about having another baby because the thought of another major surgery makes me uneasy. C-sections are no fun. 🙁

    Reply

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