What it is
The most important factor is your prior uterine incision type (usually a low-transverse; a classical or T-incision changes the calculus). ACOG considers TOLAC a safe and appropriate choice for most people with one or two prior low-transverse cesareans, no other contraindications, and access to a hospital that can perform an emergent cesarean if needed. Success rates for VBAC average 60–80%, and validated calculators can personalize your estimate. Uterine rupture — the main serious risk of TOLAC — happens in roughly 0.5–0.9% of TOLACs with a prior low-transverse incision; ERCS avoids this risk but carries the cumulative surgical risks of another cesarean, especially for future pregnancies.
Evidence review links
Each link opens the full review on the publisher's site in a new tab.
- ACOG Practice Bulletin 205: Vaginal Birth After Cesarean DeliveryACOG
- Cesarean Birth FAQACOG
- ACOG Committee Opinion 764: Medically Indicated Late-Preterm and Early-Term DeliveriesACOG
- MFMU Network VBAC Success CalculatorNICHD Maternal-Fetal Medicine Units Network
- ACOG Committee Opinion 736: Optimizing Postpartum CareACOG
Possible benefits
- TOLAC: shorter recovery if successful, lower infection risk, better outcomes for future pregnancies (fewer accreta/previa risks)[ACOG↗]
- ERCS: predictable, avoids uterine rupture risk, easier logistics[ACOG↗]
- Personalized VBAC-success calculators can guide the conversation[NICHD Maternal-Fetal Medicine Units Network↗]
Possible risks
- TOLAC: uterine rupture (~0.5–0.9% with prior low-transverse), and if it happens, higher risk of blood transfusion and neonatal harm[ACOG↗]
- ERCS: cumulative surgical risks, longer recovery, higher rates of placenta accreta and previa in future pregnancies[ACOG↗][ACOG↗]
- Both: mental-health follow-up matters — a highly-desired VBAC that becomes a repeat cesarean can be harder emotionally than a planned ERCS[ACOG↗]
Alternatives
Current evidence
ACOG Practice Bulletin 205 states TOLAC is safe and appropriate for most candidates with one or two prior low-transverse cesareans. The MFMU VBAC-success calculator is a validated tool to individualize the conversation. Uterine-rupture risk climbs with prior classical incisions, induction with prostaglandins after prior cesarean, and multiple prior cesareans.
Where the evidence is clear · where people may choose differently
For most topics, guidelines from ACOG, WHO, and other major bodies broadly agree on the core safety points (when to act in an emergency, informed-consent standards, monitoring baselines). Where reasonable people — and even guidelines — differ tends to be around thresholds (when to start or stop something), preferences (comfort, environment, support), and values (how you weigh small risks against benefits). Use the questions below to explore those pieces with your care team.
Educational only. Your care team can help you weigh what applies to your specific situation.
Related evidence topics
- VBAC — Vaginal Birth After CesareanAttempting a vaginal birth after a previous cesarean — current evidence and considerations.
- Planned (Scheduled) CesareanA cesarean scheduled ahead of time — usually for a specific medical reason (placenta previa, transverse baby, prior classical incision, some twin situations) or, less commonly, on maternal request. Knowing what to expect on the day reduces surprises.
- Cesarean RecoveryThe first hours, days, and weeks after a cesarean — pain management, incision care, moving, feeding, and when to call. Modern ERAS (Enhanced Recovery After Surgery) protocols get most people up walking within 24 hours.
- Informed Consent & RefusalYour right to information about, and to accept or decline, any proposed care.
Questions to ask your care team
- ?What was my prior incision type — low-transverse, classical, or unknown?
- ?What's my personalized VBAC-success estimate using the MFMU calculator?
- ?Is your hospital set up for immediate cesarean if needed during a TOLAC?
- ?How do you handle induction or augmentation in a TOLAC (Pitocin yes/no, Foley, misoprostol)?
- ?If this is my last planned birth vs. I want more kids — does that change your recommendation?
Universal questions (works for any decision)
A short BRAIN-style set you can bring to any conversation about interventions, monitoring, or care decisions.
- ?Why are you recommending this now — is it urgent, routine, or optional?
- ?What happens if we wait an hour (or longer) before deciding?
- ?What signs would tell us this is working — or that we need to change course?
- ?What are the alternatives, including doing nothing?
- ?What would you recommend if this were your family?
- ?What would change your recommendation?
Sources & provenance
Tap a source to open the original guideline or review in a new tab.
- ACOG Practice Bulletin 205: Vaginal Birth After Cesarean Delivery — ACOG
- Cesarean Birth FAQ — ACOG
- ACOG Committee Opinion 764: Medically Indicated Late-Preterm and Early-Term Deliveries — ACOG
- MFMU Network VBAC Success Calculator — NICHD Maternal-Fetal Medicine Units Network
- ACOG Committee Opinion 736: Optimizing Postpartum Care — ACOG
Plain-language paraphrase. Re-verify before publish.
Last reviewed: 2026-07-03
Further reading — canonical references
Read the source material directly. Each link opens the publisher's own current guidance in a new tab — cross-check what we summarize against what they say.
Tier 1 · Clinical guidelines
Tier 2 · Systematic reviews
Educational only. Guidelines evolve — the linked publisher pages will reflect newer guidance than any static snapshot.
Version history — v1.0.0
v1.0.0 · 2026-07-03 · LlaMamma editors
Initial repeat cesarean vs. TOLAC topic.
New guidance from ACOG, WHO, Evidence Based Birth, or other listed sources is recorded here and can be updated remotely without a new app release.