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Vaginal Birth After Caesarian (VBAC) or Vaginal Trial of Labour (VTOL)

Factors that increase the likelihood of successful VBAC include:

  • Previous successful VBAC
  • Previous vaginal delivery
  • Favourable cervix
  • Spontaneous labour
  • Non-recurrent indication for previous C-section (e.g. breech presentation)
  • Maternal age < 40 years

Factors that decrease the likelihood of successful VBAC include:

  • Previous C-Section done for dystocia
  • Need for induction of labour requiring cervical ripening
  • Need for augmentation of labour
  • Gestational age > 40 weeks
  • Estimated birth weight > 4000 grams
  • Maternal body mass index (BMI) > 30
  • Hypertension

Prerequisites for a trial of labour after previous Caesarean birth (these should be documented):

  • Baby is head down
  • Previous operative report (may include opinion of previous surgeon)
  • No contraindications to vaginal birth

Factors that may increase the risk of uterine rupture (these should be documented):

  • Single layer (versus two-layer) closure of the previous uterine incision
  • Large headed baby
  • Short interval from previous C-Section (< 18 months)
  • More than two previous C-Sections
  • Previous Caesarean for failure to progress after fully dilated

Contraindications to a TOL (these should be documented):

  • Any contraindications to labour
  • Previous or suspected classical C-Section
  • Previous inverted T uterine incision
  • Previous uterine rupture
  • Previous major uterine reconstruction
  • Inability of the facility to perform an emergency C-Section
  • Woman requests Elective Repeat C-Section rather than a TOL

Benefits of VBAC:

  • Shorter hospitalization
  • Shorter recovery time for the woman
  • Improved maternal satisfaction
  • Reduced health care costs


ALARM 2014

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