TOLAC

TOLAC stands for trial of labor after cesarean. It is the planned attempt to have a vaginal birth after a previous cesarean delivery, rather than automatically performing another cesarean. When the labor results in a vaginal birth, this is referred to as a VBAC (vaginal birth after cesarean).

Eligibility for TOLAC depends on individual obstetric history and current pregnancy factors. It is most commonly offered to people with a single prior cesarean delivery using a low-transverse uterine incision. Factors that increase eligibility include no contraindicating uterine scars (or locations), no placenta previa, and no medical conditions that require planned delivery by cesarean. A prior classical (vertical) uterine incision or extensive uterine surgery often makes TOLAC less favorable due to higher risk of uterine rupture. Decisions should consider overall health, cervical readiness, fetal well-being, and patient preference.

Management and monitoring are crucial for TOLAC. Planned TOLAC typically occurs in facilities equipped for emergency cesarean delivery, with trained obstetric staff, anesthesia, and rapid access to surgical care. Continuous fetal monitoring and maternal monitoring are common during labor. A written plan outlines the criteria for continuing the trial or proceeding to cesarean, and the team remains prepared to perform an emergency cesarean if signs of fetal or maternal distress arise.

Outcomes and risks vary. The main goal is a successful VBAC, which occurs in about 60–80% of TOLAC cases, depending on prior vaginal birth and other factors. The principal risk is uterine rupture, occurring in a small percentage of cases, which can necessitate urgent cesarean and carries risks for both mother and baby. Counseling should cover benefits, risks, and the resources required to support a safe TOLAC.