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TOLAC vs VBAC: Meaning, Who Can Try, and Planning Both Paths

Babysential TeamOctober 9, 202611 min read
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TOLAC vs VBAC: Meaning, Who Can Try, and Planning Both Paths

Your last baby arrived by cesarean, and the NHS says that doesn't necessarily mean this one will be a cesarean.

If you're weighing a TOLAC, a trial of labor after cesarean, this guide covers what the terms mean, who can try, the risks on each side, and how to write a birth plan for your TOLAC that covers either ending.

TOLAC is a planned attempt at a vaginal birth after a cesarean, and VBAC is that birth when it happens (ACOG). ACOG calls TOLAC appropriate for many women; ask your OB how your own history fits.

Key Takeaways

  • TOLAC is the attempt; VBAC is the outcome (ACOG).
  • Most TOLACs end in a VBAC. ACOG cites overall VBAC rates of 60-80%.
  • The main risk is rare but serious. NHS guidance puts the uterine scar opening at about 1 in 200 in a VBAC labor, against about 1 in 10,000 with a planned repeat cesarean.
  • Where you give birth matters. ACOG says a VBAC belongs in a hospital that can handle emergencies.
  • Plan both paths: labor preferences, plus a c-section section.

TOLAC Meaning: What TOLAC and VBAC Stand For

ACOG's patient FAQ frames it as a fork. After a cesarean, you can schedule another cesarean or give birth vaginally, which is a VBAC (vaginal birth after cesarean). A TOLAC (trial of labor after cesarean) is the attempt to have that VBAC. If it doesn't succeed, ACOG says you'll need another cesarean.

ACOG's Practice Bulletin 205 defines TOLAC as a planned attempt at vaginal birth after a cesarean, "regardless of the outcome."

Who Can Try a TOLAC?

ACOG's 2021 practice advisory says your values and preferences come first in a shared decision with your clinician. An ACOG Expert View article on choosing between a VBAC and a repeat cesarean lists what ob-gyns weigh:

  • Your uterine incision. ACOG's FAQ says a low transverse (side-to-side) cut carries the least chance of rupture, a low vertical cut more, and a high vertical, or "classical," cut the most; the article says a VBAC is usually not recommended after a classical cut. Ask your OB whether this applies to you.
  • Your records. Your skin scar doesn't show the cut on your uterus, so ACOG suggests getting your last cesarean's records.
  • The reason for that cesarean. A breech baby may not happen again; a labor that stalled is more likely to.
  • Health conditions. The article lists obesity, preeclampsia, a larger-than-average baby, going past 40 weeks and less than 19 months since your cesarean as lowering your chances, and says placenta previa calls for a planned cesarean. Ask your OB whether this applies to you.
  • Family plans. Risks rise with each repeat cesarean, so hoping for a larger family can be a reason to consider a TOLAC.

The Oxford NHS leaflet names few situations where a VBAC is not advisable: a uterus that ruptured in a previous labor, a previous classical incision, or another complication that needs a cesarean.

VBAC After 2 C-Sections

ACOG's public pages give no figures here; these are NHS figures. The Oxford leaflet reports about 71 in 100 having a vaginal birth after two or more cesareans. The NHS Greater Glasgow and Clyde guideline calls the safety evidence limited, puts the rupture risk at around 1 or 2 in 100, and asks for a detailed talk with your senior obstetrician.

ACOG's FAQ adds that a VBAC may help you avoid problems linked to multiple cesareans, such as bladder injury and placenta problems. Ask whether your hospital supports a TOLAC after two.

TOLAC Risks and Benefits, Compared With a Repeat Cesarean

Numbers about your own baby are hard to read; bring what worries you to your OB. ACOG's FAQ calls scar rupture a rare but serious VBAC risk; the Oxford leaflet calls both choices safe, each with different risks. The figures below are from the NHS.

TOLAC (all attempts, unless marked VBAC)Planned repeat cesareanSource
Uterine scar openingAbout 1 in 200About 1 in 10,000NHS Glasgow
Baby dying in labor or as a newborn (Oxford: or brain damage)About 1 in 1,000, as in a first pregnancy (Glasgow); about 2 in 1,000 (Oxford)About 1 in 10,000 (Glasgow); about 1 in 1,000 (Oxford)NHS Glasgow, Oxford NHS
Baby's breathing problemsVBAC: about 1 in 100About 4 in 100Oxford NHS
Blood clot for youVBAC: about 2 in 1,000About 1 in 100Oxford NHS
Plans changingAbout 1 in 4 end in an emergency cesareanAbout 1 in 10 go into labor firstOxford NHS

VBAC rows count only TOLACs that end in a vaginal birth (see below). A planned repeat cesarean gives you a known date, though with a longer operation and recovery (Oxford NHS). The NHS adds that a cesarean can raise the risk of placenta problems in a later pregnancy.

Uterine Rupture

ACOG calls rupture of the uterus rare but very serious for you and your baby, and says a VBAC should not be tried if you're at high risk of it. The Oxford leaflet says the chance falls to about 2 in 1,000 after a previous vaginal birth, and recommends a delivery suite with continuous heart-rate monitoring and an operating room close by.

Benefits of a Successful VBAC

ACOG lists no abdominal surgery, a shorter recovery, a lower risk of infection and less blood loss, and notes that many people want the experience of a vaginal birth.

If the TOLAC Ends in a Cesarean

ACOG's Practice Bulletin 205 says a TOLAC that ends in a cesarean brings more complications than either a VBAC or a planned repeat cesarean. The Oxford leaflet puts an emergency cesarean at around 1 in 4, usually because labor slows or there's concern for your baby.

What Are Your Chances? The VBAC Calculator

ACOG calls the 2007 NICHD calculator, from the Maternal-Fetal Medicine Units (MFMU) Network, the most widely validated. Its 2021 advisory, reaffirmed in September 2025, explains the update:

  • The 2007 version used race and ethnicity alongside age, body mass index and birth history.
  • The 2021 version (Grobman and colleagues, 2021, cited by ACOG) drops race and ethnicity, since ACOG says outcome differences by race are not biologically based, and adds chronic high blood pressure treated with medication.

ACOG says estimates are more likely to be accurate at 60% or higher and deviate substantially at 40% or lower, and that a calculator score should not be used as a barrier to a TOLAC.

You can try the MFMU Network's VBAC calculator yourself; ACOG's Expert View article says it asks for your age, height, current and prepregnancy weight, birth history and any treated high blood pressure. Bring the result to your OB as a starting point.

Can Labor Be Induced During a TOLAC?

ACOG's FAQ says an induction can lower your chance of a vaginal birth and may raise complications, and the Expert View article says a repeat cesarean may be safer if you need an induction. ACOG's labor induction FAQ says some prostaglandins aren't used after a cesarean for that reason.

The Oxford leaflet gives about 1 to 2 in 100 for scar rupture with induction. The Glasgow guideline gives 8 in 1,000 with mechanical methods, such as a balloon, and 24 in 1,000 with prostaglandins.

Where You Give Birth: Hospital Requirements for a TOLAC

ACOG says a VBAC should take place in a hospital that can manage life-threatening emergencies, and that some hospitals don't offer VBAC for that reason. The Expert View article lists anesthesia in the hospital 24/7, a blood bank, an intensive care unit and a NICU.

ACOG's Committee Opinion 697, reaffirmed in 2026, calls a prior cesarean an absolute contraindication to planned home birth.

Bloom's location step offers "Hospital labor & delivery," "Birthing center," "Home birth" and "Not sure yet." Ask your OB or midwife what ACOG's hospital-resources statement means for where you plan to give birth.

Plan Both Paths: Your TOLAC Birth Plan

Plan for both endings: your wishes for labor, and your wishes if labor ends in a cesarean.

Your Labor Preferences

  • Monitoring and movement. Both NHS documents recommend continuous monitoring of your baby's heartbeat; Oxford's wireless monitors let you move and use the pool. See which positions work with monitoring, then mark yours in Bloom's positions step, such as "Standing or upright" or "Open to suggestions."
  • Pain relief. The Glasgow guideline says an epidural is not ruled out in a VBAC labor. Our epidural pros and cons guide covers the trade-offs, and our peanut ball guide covers changing position in bed with one.
  • Support. Pick a partner or "Doula" in Bloom's support step and add names in its "Names and roles" box. Our guide to who can be in the delivery room covers hospital rules.
  • Special wishes. In Bloom's Special wishes box, note where your cesarean records are and how you'd like changes explained.

If Labor Ends in a Cesarean

Bloom's "If a c-section becomes necessary" step covers this half, with options such as "Partner present" and "Skin-to-skin as soon as possible." Our c-section birth plan guide explains each one.

It works the other way too: if labor starts before a booked repeat cesarean, ACOG says a VBAC may be worth considering if labor is far along and your baby is healthy.

A TOLAC plan has two halves, and Bloom has both. Tick your labor preferences, fill in the "If a c-section becomes necessary" step, then download both as one PDF or email the plan to your care team. Build your TOLAC birth plan in Bloom.

For a filled-in version, see a sample VBAC birth plan.

Questions to Ask Your OB About a TOLAC

  • Ask which uterine incision you had, and whether your records are on file.
  • Ask for your personal chance of a VBAC, and how sure that estimate is.
  • Ask whether your hospital offers TOLAC, with anesthesia there around the clock.
  • After two cesarean births, ask about hospital policy and their recommendation.

Frequently Asked Questions

What does TOLAC mean?

TOLAC stands for trial of labor after cesarean. ACOG defines it as a planned attempt to give birth vaginally after a previous cesarean, whatever the outcome.

What is the difference between TOLAC and VBAC?

TOLAC is the attempt and VBAC is the result. ACOG says a TOLAC that succeeds ends in a vaginal birth after cesarean (VBAC), and one that doesn't ends in another cesarean.

What is the VBAC success rate?

ACOG cites overall VBAC rates of 60-80% for people who have a TOLAC. An Oxford NHS leaflet gives about 3 in 4 after one cesarean for a low-risk pregnancy when labor starts on its own.

Can you have a VBAC after 2 c-sections?

It can happen. NHS guidance calls the evidence limited and puts the risk of the scar opening at around 1 or 2 in 100; an Oxford NHS leaflet reports about 71 in 100 succeeding. Ask your OB what they advise.

How does the VBAC calculator work?

It estimates your chance of a VBAC from details such as age, height, weight and birth history. ACOG says the 2021 version drops race and ethnicity, is less accurate at low estimates and should not be a barrier to a TOLAC.

Can labor be induced during a TOLAC?

Sometimes. ACOG says induction can lower the chance of a vaginal birth and raise the risk of the scar opening. Oxford NHS gives about 1 to 2 in 100 for scar rupture with induction.

Your Next Step

Take these questions to your next prenatal visit, then fill in your birth plan with both paths.

This article is for information only and does not replace medical advice from your OB or midwife.

How This Guide Was Made

The Babysential Team wrote this guide from the ACOG and NHS documents below, checked on October 9, 2026, with AI-assisted drafting. ACOG's Practice Bulletin 205 is members-only beyond its public summary, so NHS figures fill the gaps in ACOG's public pages.

Sources

TOLAC vs VBAC: Meaning, Who Can Try, and Planning Both Paths illustration

Sources & Disclaimer:This article is for informational purposes only and does not constitute medical advice. Always consult your healthcare provider for personalized guidance regarding your or your child's health.

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