Information, preparation, and teamwork are needed for a successful vaginal birth after cesarean (VBAC).
Childbirth and VBAC education
To prepare for labor, consider taking a childbirth education class at your local hospital or clinic. You and your birthing partner can learn:
- What to expect during labor and delivery.
- How to manage the birth using controlled breathing and emotional and physical support.
- What medical pain-control options may be available for a vaginal delivery.
Other than requiring closer monitoring, trial of labor after cesarean, or TOLAC labor, is the same as normal labor. During early labor, a woman can remain as active and mobile as she wants. There are no specific restrictions for TOLAC until active labor begins. During the active period of labor, continuous fetal heart monitoring is done to watch for early signs of fetal distress or uterine rupture. (For more information, see Exams and Tests.)
If you are attempting trial of labor and you have not had a previous vaginal birth or your previous cesarean was done early on in labor, your labor will be like a first-time labor.
For more information about labor and delivery, see the topic Labor and Delivery.
Medicines for starting or strengthening a trial of labor
As the end of pregnancy nears, the cervix normally becomes soft and begins to open (dilate) and thin (efface), preparing for labor and delivery. When labor does not naturally start on its own, labor may be started artificially (induced).
Some doctors avoid the use of any medicine to start (induce) a trial of labor, because they are concerned about uterine rupture. Other doctors are comfortable with the careful use of oxytocin (Pitocin) to start labor when the cervix is soft and opening (dilating).
If your labor slows or stops progressing, your doctor may use oxytocin to strengthen (augment) contractions.
As with most vaginal births, most women who choose VBAC can safely use pain medicine during labor.
Pain medicine usually is started when the cervix has opened (dilated) 3 cm (1.2 in.) to 4 cm (1.6 in.). Types of pain medicines used include:
- Local anesthesia, which numbs the small area where the medicine is injected.
- Epidural anesthesia, which partially or fully numbs the entire lower part of the body. Studies have shown that epidural anesthesia does not increase uterine rupture rates during vaginal birth after cesarean (VBAC) trials of labor.3
- Opioids (narcotics), which partially relieve pain and help you relax.