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
- 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
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
- Opioids (narcotics), which partially relieve pain and help you