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Deciding on a TOLAC? - ACOGs Recommendations broken down.

Updated: Dec 19, 2019

When trying for a VBAC, there are some things you should think about to make a balanced decision. No matter where you go, you will hear many opinions about if a caesarean is safe for you or not. You may even overhear people telling you-you're an irresponsible mother because you have chosen to have a VBAC. Nonetheless, it would be wise to know what recommendations and guidelines support or discourage particular practices for your records and to shut them up...

Motherhood is about making decisions to protect your child whether unborn or born. So don't mind them. Anyways, I wanted to break down what ACOG says about making your mind up if a VBAC is right and safe for you, in their patient's FAQs, in an easy to understand guide.

1. What is a VAGINAL BIRTH AFTER CAESAREAN (VBAC)?Vaginal birth after c-section is when a mother has previously had an operation to remove her baby from her womb and decides to have a vaginal birth for her next pregnancy. ACOG provides two ways to birth your next baby following your previous c-section, showing you, you have a choice. You can have a repeat c-section, or, you can plan for an empowering, incredible VBAC.

2. What is vaginal birth after c-section (VBAC)?A VBAC is when a mother has a live birth through her vagina after a previous c-section. This could be a 100% "natural birth" or a birth that is medically stimulated. As long as the baby comes out her vagina, it's classed as a VBAC.

3. What is a trial of labour after cesarean (TOLAC)?A TOLAC means a trial of labour and is a term given to all women trying for a vaginal birth after a previous c-section. It means she is given a trial run to see if she can birth her baby vaginally. In the birthing industry, there is a large number of birth professionals who agree that using certain phrases to describe the birth or a mother should not be done.

Using the term "trial of labour" or "a trial of your scar", can offend some mothers, as it did me when I was pregnant and in labour. A Vaginal birth after your previous c-section (VBAC), can either result in a successful VBAC or an unsuccessful VBAC and you will require a repeat c-section.


4. What are some of the benefits of having a VBAC?As you can imagine, having a VBAC outweighs having a c-section for the majority of mothers, unless a medical emergency takes place which would prohibit you from having a VBAC.

A medical emergency occurs when either your life or your unborn babies life is IN DANGER. Having a VBAC has some incredible benefits, and ACOG has presented a few of these benefits. For example: No surgeryNo abdominal surgery Lower risk of infection delayed cord clampingBeing able to hold your baby firstLess blood loss Shorter recovery period And there are way more benefits Remember, if you have a certain amount of blood loss it can be dangerous and it may be classed as a haemorrhage. If you have a vaginal birth, you are less likely to have a significant amount of blood loss like you would have done' if you have a c-section. That's not to say a Postpartum Haemorrhage is not possible.

When a woman has many c-sections, every time she becomes pregnant, she will probably experience difficulties from birth professionals who are anti-mothers having a VBAC. ACOG says: Many women would like to have a vaginal birth.

For women planning to have more children, VBAC may help them avoid specific health problems linked to multiple cesarean deliveries. These problems can include bowel or bladder injury, hysterectomy, and problems with the placenta in future pregnancies. If you're planning to have more children, this may figure into your decision.

Now we know having a VBAC can be an enjoyable experience, but being balanced allows us to understand there are risks to having a VBAC if it's unsuccessful. ACOG tells us some of the risks are: Uterine rupture

blood loss

infection

and many other complications.


ACOG makes it very clear that "uterine rupture is rare", but if it does happen it can be catastrophic, causing a severe threat to your life and the baby's life. If you've previously had a uterine rupture, ACOG advises you not to have a VBAC.

Why is the type of uterine incision used in my previous cesarean delivery important?Knowing what incision you have on your uterus will help you make a balanced, evidence-based decision; whether to have a VBAC or not. Depending on your incision type will depend on the likelihood of your scar rupturing. ACOG explain the different types of scars a mother may have. Some scars are more high risk, and carry more or less of a chance of you having a uterine rupture.

ACOG says, women who've got a low transverse scar, a scar from side to side on your bikini line, you are at a lower risk of experiencing a uterine rupture. But if you've got a horizontal scar, whether high or low on your uterus, you have a very high risk of having a uterine rupture.

Where can I have a VBAC?

ACOG advises women to have a VBAC in a hospital where there are facilities to aid an emergency should one arise. They also tell mothers that not every birth professional or hospital will offer VBAC services because they may not be equipped to deal with an emergency if it happens.

Are there things that can happen during labour that may change my labour plan?Labour is so amazing, but as we know; things can change at any time which can affect what we want and have written down in our birth plans. Labour may start, and everything is on track and having a VBAC seems like a safe and beneficial thing to do but your labour may take another route and having a VBAC may be a risky, dangerous thing for you to continue. ACOG says: If you have chosen to try a VBAC, things can happen that alter the balance of Risks and benefits. For example, you may need to have your labour induced (started with drugs or other methods). This can reduce your chances of a Successful vaginal delivery.


Labour induction may also increase your Chances of complications during labour. If circumstances change you and your ob-gyn or other healthcare professionals may want to reconsider your decision.


I love these recommendations because it's not biased or one sided. I mean, if I could change anything, it would be to add more information on women having home-births at home. But everything else seems really balanced. We most definitely need to do more research into VBACs and come to a balanced overlook at it. I mean, why are so many women having successful VBACs? What are we doing differently? Why are the c-section rates getting higher and higher even though we're reporting more women having vaginal births? These are all questions I'm looking much deeper into.

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