Many women in the United States deliver their babies by Cesarean
Section, an operation where the baby is born through a cut in the
mother's abdomen and uterus. For many years doctors believed that if a
mother had one cesarean section, she must have a cesarean section to
deliver any other babies. Studies have shown that it is safe for most
women who have had a C-section in the past to try to have a vaginal
birth This is called a "Trial Of Labor After Cesarean" or TOLAC, and
"Vaginal Birth After Cesarean" or VBAC.

Although it is safe for most women to try a TOLAC/VBAC there are some
women with risk factors that might make it unsafe. Your provider will
review your history and records to determine if it would be safe for you
to try a TOLAC/VBAC. Most experts encourage mothers who do not have risk
factors to attempt a TOLAC/VBAC. At UNM we feel that it is the best
choice for many of our patients.

There are advantages and disadvantages to either a repeat Cesarean
Section or a TOLAC/VBAC. There are some risks to both these choices. The
decision about whether to try a TOLAC/VBAC is a very personal one. This
information sheet provides general facts about repeat Cesarean Section
and TOLAC/VBAC. Please discuss your personal case with your provider to
help you make the right decision for you.

Advantages to you of having a TOLAC/VBAC:

-   **[Less risk to the mother]{.underline}**. Women who have a vaginal
    birth have less chance of getting an infection in the uterus.
    Usually there is less bleeding and less risk of getting a blood
    transfusion.

-   **[Shorter recovery time]{.underline}**. Most women can leave the
    hospital one or two days after a vaginal delivery. Most women stay
    at least three days after a Cesarean Section. After going home,
    women who have had a vaginal delivery usually go back to normal
    activities sooner than those who have had a Cesarean Section. There
    is usually much less pain after a vaginal delivery.

-   **[More involvement in the birth]{.underline}**. Many women feel a
    vaginal delivery allows them to be more involved in the birth
    process. After a vaginal delivery the mother can usually hold the
    baby right away and begin nursing. After a Cesarean Section, the
    mother can't hold the baby or nurse until the operation is over and
    the mother recovers from anesthesia. More than one family member may
    be in the room for a vaginal delivery if the patient wishes. Only
    one person can be in the room for a Cesarean Section. If the mother
    needs general anesthesia (goes to sleep) no one is allowed to be in
    the room.

Disadvantages of a TOLAC :

-   **[Unsuccessful labor]{.underline}**. Not all women who try to have
    a vaginal delivery are successful. Mothers who need a repeat
    Cesarean Section [after]{.underline} an unsuccessful labor may have
    a greater risk of infection, bleeding and blood transfusion or
    injury to nearby organs such as the bowel and bladder. At UNM about
    two thirds of the women who try a TOLAC have a successful VBAC.

-   **[Rupture of the uterus]{.underline}**. There is a small chance
    that the scar in the uterus from the previous Cesarean Section may
    rupture, or come apart, in labor. If this happens, an emergency
    Cesarean Section is required. There is a risk that the baby may
    suffer serious injury or death if too much time goes by from when
    the uterus ruptures until the baby is delivered. At UNM, there are
    staff in the hospital 24 hours a day to do an emergency Cesarean
    Section. In most cases the baby can be delivered before it is
    harmed. Rupture of the uterus also increases the risk to the mother
    of injury to the nearby tissues, such as the bladder or bowel. There
    is a small risk of needing a hysterectomy.

> (OVER)

Other issues:

-   **[Pain]{.underline}**. Many women worry that labor may be painful
    and that a Cesarean Section will mean they don't have to go through
    the pain of labor. Although labor is painful, there are many ways to
    give pain relief. Medicine may be given through an IV and this works
    for many patients. Epidurals (a procedure that numbs the abdomen so
    that the patient does not feel labor pains) are available for women
    who want them. Women who have a Cesarean Section usually have more
    pain for a longer time than women who have a vaginal birth.

**- [Pitocin]{.underline}.** The medicine Pitocin is used to start labor
or help it along if it is not progressing normally. Many studies show
that Pitocin does not increase the risk of problems for women undergoing
TOLAC/VBAC. At UNM we use Pitocin in patients trying a TOLAC/VBAC if it
is needed.

-   **[Monitoring]{.underline}**. Patients trying a TOLAC/VBAC at UNM
    have continuous monitoring of the baby's heart rate and uterine
    contractions. Also an IV will be placed. This helps us to identify
    problems and do a Cesarean Section quickly if necessary.

This information should help you decide if you want a TOLAC/VBAC or a
repeat cesarean section for the birth of your baby. Please talk to your
provider about any questions you have so that you may get the
information you need to help make this choice. It may also help to talk
to family members. Either way you decide, our goal is to provide you
with the best possible care for a good outcome---a healthy mother and
healthy baby.

I have read the information sheet and have had the chance to discuss it
with my provider. I feel that all my questions have been answered.

\_\_\_\_\_\_\_ I choose a trial of labor and vaginal birth after
cesarean section.

\_\_\_\_\_\_\_ I choose to have a repeat cesarean section.

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