VBAC — Vaginal Birth After Cesarean — Evidence Library

What it is

Planning to labor and give birth vaginally after one or more previous cesareans, sometimes called TOLAC (trial of labor after cesarean).

Evidence review links

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Possible benefits

Avoids repeat major surgery when successfulReview sources ↓
Shorter recovery than repeat cesareanReview sources ↓
Fewer risks in future pregnancies for many peopleReview sources ↓

Possible risks

Small risk of uterine rupture, higher with certain scar types or induction methodsReview sources ↓
If TOLAC is unsuccessful, ends in cesarean with its own risksReview sources ↓

Alternatives

Planned repeat cesareanReview sources ↓

Current evidence

ACOG considers TOLAC/VBAC a reasonable and safe option for many people with one prior low-transverse cesarean when a facility can respond to emergencies. Benefits include avoiding repeat surgery when successful; the major rare risk is uterine rupture. Induction and augmentation choices matter in VBAC planning: Foley/mechanical ripening is commonly considered, while misoprostol is generally avoided with a prior uterine scar. Ask for individualized success factors rather than a generic calculator alone.

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.