Attempted vaginal birth after cesarean (TOLAC) at Genesis Dnepr

What is a trial of labor after cesarean (TOLAC): it is the management of labor through the natural birth canal in a woman who has previously undergone a cesarean section. This approach may be appropriate when clinical conditions are favorable and the woman wishes to attempt a vaginal birth, but it is not suitable for everyone. The history of the previous operation, the condition of the uterine scar, pain-relief options, and the criteria for converting to a repeat cesarean should be discussed in advance with the doctor and obstetrician. The final decision is made individually based on medical assessment and may change during labor in the interest of the safety of the mother and baby.

What this mode of delivery means

A trial of labor after cesarean (TOLAC) is attempting labor and vaginal delivery in a woman with a previous cesarean section. This approach requires preparatory assessment and careful intrapartum monitoring, and is not an automatic “on-demand” option. It is important to discuss beforehand with your doctor and obstetrician the history of the prior surgery, the condition of the scar, and the available pain-relief options. During labor, decisions remain clinical and may change in the interest of maternal and fetal safety.

Practical essence: an attempt at vaginal delivery after a previous cesarean.
Difference from a planned repeat cesarean: active monitoring and readiness to change the plan.
Antepartum assessment: surgical history, time since the prior cesarean, condition of the scar, analgesia/anesthesia options.
In labor: monitoring of the fetus, the mother’s condition, and the progress of labor.
The decision is made by the doctor and obstetrician based on examinations and the course of labor.
Limitations: not all cases are suitable; the final decision is individualized.

Discuss individual indications and a birth plan in advance; the plan may change during labor in the interest of safety.

Who this format may be suitable for

A trial of labor after cesarean (TOLAC) is considered an option for managing labor in women with a previous cesarean delivery, when clinical conditions are favorable and there is a desire to discuss vaginal delivery. This option may not be appropriate for everyone — the decision depends on assessment of the maternal and fetal condition. It is useful to discuss the surgical history, monitoring criteria, and pain relief options in advance with the doctor and midwife/obstetrician. The birth plan is individualized and may be adjusted during labor.

A desire to discuss the birth plan and possible courses of action in advance.
A pregnancy without serious complications according to monitoring data.
A need for a calm, clear birth plan with defined criteria.
A wish to remain active during labor and to participate in the process.
Discussion of analgesia options and possibly an advance consultation with an anesthesiologist.
Understanding who (doctor and midwife) will manage the labor and how decisions are made.
Previous birth experience that should be taken into account when planning.
Whether a partner may be present is discussed based on organizational and medical considerations.

Discuss the possible birth plan in advance with the maternity team. During labor, the plan may be changed in the interest of the mother’s and baby’s safety.

When a trial of labor after cesarean (TOLAC) may be unsuitable or require restrictions

TOLAC may be unsuitable or require restrictions in a number of clinical situations, and this is a normal part of birth planning. Such decisions are made to protect the health of the mother and baby, not to deny the woman's preferences. It is helpful to discuss possible limitations in advance so you are prepared for an alternative plan.

Obstetric complications requiring immediate intervention.
Signs of fetal distress on monitoring.
Need for an urgent expedited delivery (surgery).
Contraindications to the chosen method of anesthesia, confirmed by the anesthesiologist.
Infectious or organizational restrictions that prohibit the partner's presence.
Concerns about the integrity of the uterine scar from a previous cesarean.
Maternal condition in which safety takes precedence over the original birth plan.

The decision to change the birth approach is made by the obstetrician and midwife based on the current assessment of mother and baby. The birth plan is adjusted as necessary in the interest of safety.

Who decides on the mode of delivery

The decision about the mode of delivery is not made at a single moment and is usually taken by a team together with the patient. You state your preferences and concerns, and the medical team evaluates the clinical picture, test results, and the condition of the fetus. For TOLAC (trial of labor after cesarean) a careful pre-assessment of the scar and the current situation is especially important. The plan is recorded as preliminary and may be adjusted during labor for medical reasons.

Patient — expresses preferences, questions, and readiness for different scenarios.
Obstetrician and midwife — assess the pregnancy, ultrasound, test results, and history of previous surgery.
Fetal monitoring and the progress of labor — key data for choosing the delivery mode.
Anesthesiologist — involved when discussing pain relief and possible contraindications.
Neonatologist — participates when there is increased risk to the newborn or in preterm labor.
Joint discussion — forming a plan that takes into account the clinical picture and the patient’s wishes.
Medical indications — the basis for changing the plan at any time during labor.

The final decision is made together with you and the maternity team based on current data. In the interest of the mother’s and baby’s safety, the plan may be revised during labor.

What to discuss with your doctor before labor

Before the consultation, it’s helpful to make a list of questions — this will help you understand which decisions need to be made in advance and what can be arranged when planning a TOLAC (trial of labor after cesarean).

Discussing things makes the plan clearer and reduces uncertainty, but does not guarantee a fixed outcome.

Ask questions directly and write down the maternity team’s answers.

What birth format do I prefer, and how realistic is a TOLAC in my case?
Can my partner be present during labor, and are there any restrictions?
What pain-relief options are being considered, and is an anesthesiologist consultation needed?
How does a previous cesarean section or prior birth experience affect the management plan?
Are there chronic conditions or regular medications that need to be taken into account?
Which ultrasound and test results are important now, and are additional examinations needed?
What is the plan if the mother’s condition worsens or there are signs of fetal distress?
When, based on signs of contractions, is it best to go to the hospital?
What documents and items are recommended to take with me to the maternity hospital?
How is the postpartum stay organized, and in what cases is early discharge possible?

Write down the answers and discuss details with your doctor and midwife so you feel prepared. Remember that the plan may be adjusted during labor in the interest of safety.

How preparation for an attempted vaginal birth after cesarean goes

Preparation for an attempted vaginal birth after cesarean (VBAC) — also called a trial of labor after cesarean (TOLAC) — is a sequence of assessments and consultations that help determine how realistic the chosen plan is.

The aim of preparation is to collect up-to-date information, discuss possible scenarios, and agree in advance on key management points.

This process reduces uncertainty but does not guarantee that the initial plan will be maintained.

Consultation with an obstetrician-gynecologist to assess the history of the previous cesarean and the current pregnancy status.
Detailed review of the maternity record and documents confirming the results of prior examinations.
Scheduled ultrasounds and laboratory tests according to gestational age.
Discussion of the birth plan: criteria for continuing TOLAC and possible alternative scenarios.
Consultation with an anesthesiologist if needed and discussion of pain-relief options.
Discussion of the partner’s involvement: logistical requirements, restrictions, and practical preparation.
Instructions on what to pack and recommendations on timing and which signs should prompt going to the maternity hospital.

Preparation makes the plan clearer and safer, but the final decision may change during labor.

In the interests of the mother and baby, the maternity team will adjust the chosen plan if necessary.

How labor proceeds during a trial of labor after cesarean (TOLAC)

During a trial of labor after cesarean (TOLAC), labor generally follows the standard sequence, with increased attention to the uterine scar and continuous fetal monitoring. It’s important to understand that the birth plan is discussed in advance between the care team and the patient, but it may be adjusted during labor. Below is a typical sequence of steps to help you picture what will happen in the delivery room.

Admission to the maternity unit — registration, measurements (vitals), and introduction to the team.
Initial examination — assessment of cervical dilation, contraction frequency, and overall condition.
Information exchange — review of the previous cesarean, patient preferences, and possible scenarios.
Connection to monitoring — tracking the fetal heart rate and contraction intensity.
Monitoring labor progress — regular checks of progress and the fetus’s response.
Involvement of the obstetrician and midwife — examinations, decision-making, and planning for operative delivery if needed.
Discussion of pain relief — agreeing on options with the anesthesiologist, if relevant.
Pushing stage — support during pushing and medical assistance as indicated.
Birth of the baby — initial assessment of the newborn and any necessary neonatal interventions.
First hours after birth — observation of the mother and baby, and help with establishing breastfeeding.

Every case is individual, and the team may change the plan in the interest of the mother’s and baby’s safety. Ask questions in advance and stay in contact with your doctor and midwife for timely decision-making.

Pain relief for a trial of labor after cesarean (TOLAC)

The question of pain relief for TOLAC is discussed in advance and planned with involvement of an anesthesiologist. The choice of method depends on clinical assessment, the condition of the uterine scar, and the overall course of the pregnancy.

It is not possible to guarantee complete absence of pain in advance — the team’s task is to reduce discomfort while maximizing safety.

Discussion of pain management at a scheduled consultation with the anesthesiologist and obstetrician.
Assessment of contraindications to specific methods and their associated risks.
Epidural anesthesia may be an option if there are no contraindications.
The choice of method is made jointly by the physician, obstetrician, and anesthesiologist.
The pain-relief plan can be adjusted during labor if the situation changes.
Maternal and fetal monitoring is performed when anesthesia is used to allow prompt response.
Organizational and infection-control constraints may affect the presence of a partner.
Some clinical conditions make certain anesthesia methods unsuitable.

Discuss your preferences and limitations in advance with the maternity team; during labor the choice of analgesia may be revised in the interest of the mother’s and baby’s safety.

Safety and monitoring during an attempted vaginal birth after cesarean

Monitoring and surveillance are basic elements of safety during an attempted vaginal birth after cesarean. In the delivery room the team observes the condition of the mother and baby so they can respond promptly to any changes. The birth plan is discussed in advance but may be adjusted as events unfold in the interest of safety.

Continuous monitoring of the mother's condition and vital signs.
Assessment of the fetal heart rate using CTG (cardiotocography) when indicated.
Regular examinations by the obstetrician and midwife to assess labor progress.
Monitoring contraction intensity and the progression of cervical dilation.
The team’s readiness to rapidly change management if indicators worsen.
Prioritizing the safety of the mother and baby when choosing further management.

Monitoring is a normal part of labor care; it allows timely and well-founded action. If necessary, the team will adjust the birth plan for the safety of the mother and baby.

What happens if labor doesn't go according to plan

A birth plan is a guideline that the team may revise if the situation changes. In the delivery room, doctors and midwives monitor the condition of the mother and baby and act in the interest of safety. Changing tactics is standard practice, not a sign of error; you will be informed about the reasons and the available options.

- The team may promptly revise the plan and immediately inform you and your partner.
- Your partner may be temporarily asked to leave the delivery room for medical or organizational reasons.
- A shift from spontaneous labor to augmentation of labor if progress slows.
- Planning an emergency cesarean section (including a repeat cesarean if applicable) if there is a threat to the mother or fetus.
- Cancellation or inability to provide epidural anesthesia if there are contraindications.
- A change from upright or active birthing positions to a more controlled position if necessary.
- Prioritizing safety: the initial plan of minimal intervention may be revised.
- Preparing the operating room and the neonatal team for rapid intervention if the baby’s condition deteriorates.

Changing the plan is done for your and your baby's safety; the team will explain the next steps and options in detail.

Possible risks and limitations

Any mode of delivery, including a trial of labor after cesarean (TOLAC), has its limitations and associated risks. These depend on the condition of the mother and baby, the history of previous deliveries, and the course of the current pregnancy. The doctor and midwife discuss likely scenarios and the criteria for changing the plan in advance. This helps with preparation but does not rule out the need for operative decisions if the situation changes.

- Medical limitations related to the condition of the uterine scar.
- Deterioration of the fetal condition requiring immediate intervention.
- The need for an emergency repeat cesarean section in life‑threatening situations.
- Restrictions on certain analgesia or anesthesia methods when contraindicated.
- Organizational or infection‑related restrictions affecting the partner’s presence.
- The need for augmentation of labor if progress is slow.
- Limited predictability — the plan may change at any time during labor.

Discuss possible risks and the criteria for changing the plan in advance with the maternity unit team. In the interest of safety, any changes will be explained and agreed upon whenever possible.

What happens immediately after birth

The first hours after the baby’s birth are spent under observation by the team and are used to assess the condition of the mother and the newborn. Standard checks are carried out in the delivery room — CTG (cardiotocography) and an examination of the newborn by a neonatologist are always performed. Many procedures are aimed at establishing contact, monitoring wellbeing and providing initial care; the specifics depend on the health of the mother and the baby.

Initial skin-to-skin contact between mother and baby, if both are well enough.
Performing CTG and an initial examination of the newborn by a neonatologist — standard practice.
Monitoring the mother’s condition: blood loss, blood pressure and overall wellbeing.
Assistance with the first breastfeeding and basic feeding advice.
Care of the perineum, and minor medical interventions if necessary.
Transfer to the postpartum ward once the mother and baby are stabilized.
Information about further monitoring, tests and the expected timing of discharge.

The team (doctor and midwife) will explain what happened and answer your questions.

Remember that the order of actions may change depending on the situation to ensure safety.

Role of the physician and the team

Labor is managed by a team of specialists; each is responsible for their part of the process and decisions are made jointly. This approach provides continuous monitoring, rapid response to changes, and support for the patient at all stages. When attempting a trial of labor after cesarean (TOLAC) — i.e., attempting a vaginal birth after cesarean (VBAC) — teamwork is especially important for risk assessment and choice of strategy.

Obstetrician-gynecologist — assesses risks, makes clinical decisions, and coordinates the team.
Midwife — monitors labor progress, supports the patient, and performs necessary procedures.
Anesthesiologist — advises on pain relief, assesses contraindications, and provides anesthesia if needed.
Neonatologist — examines the newborn and provides neonatal support if necessary.
Operating/surgical team — prepared for emergency intervention and ensures safety if conversion to surgery is required.
The doctor and midwife regularly inform the patient about labor progress and explain the reasons for any changes in the plan.
Monitoring and regular examinations allow timely adjustment of tactics in the interest of safety.

The team works to support you and to make decisions based on the current clinical situation. Open communication is important — ask questions and discuss your preferences with the medical staff.

How this format benefits the patient

This format gives the patient a clearer birth plan and the opportunity to discuss key management points in advance. It helps reduce uncertainty and coordinate team roles, pain-relief options, and organizational issues.

It is important to understand, however, that the final decision depends on the clinical situation during labor.

- A clear action plan with predefined criteria for changing the approach.
- The ability to discuss and document personal preferences for labor management in advance.
- The option to choose and arrange for the presence of a specific physician.
- Reduced uncertainty through preparatory examinations and consultations.
- Access to the discussed pain-relief options with involvement of an anesthesiologist if needed.
- Partner presence as an option depending on organizational and medical considerations.
- Continuous monitoring and the team's readiness to change tactics quickly if necessary.

These conveniences help you feel prepared, but the plan may be adjusted in the interest of the mother’s and baby’s safety.

How the pre-delivery consultation works

A pre-delivery consultation is a structured conversation with the medical team aimed at assessing the current situation and forming a safe plan. When discussing a trial of labor after cesarean (TOLAC), doctors take into account the history of previous surgeries and the results of examinations. Several visits may be needed to clarify data and agree on details. The goal of the consultation is to prepare you for different scenarios and answer any questions that arise.

History taking: previous deliveries, cesarean(s), and current complaints.
Review of the maternity record (exchange card) and existing medical documents.
Review of ultrasound results, laboratory tests, and other relevant examinations.
Discussion of your preferences for the birth (type of delivery) and partner attendance.
Joint assessment by the doctor and midwife of possible limitations and risks.
Discussion of pain relief/analgesia and referral to an anesthesiologist if necessary.
Development of a preliminary birth plan with criteria for changing the approach.
Explanation of which signs mean you should go to the clinic/hospital, and answers to questions.

Bring your maternity record (exchange card) and a list of questions you want to discuss. The plan may be adjusted as new information becomes available or during labor.

Please note that online consultations are available for patients from other cities. We often receive requests from Zaporizhzhia, Pavlohrad, Kamenskoye (Dniprodzerzhinsk), Novomoskovsk (Samar), Kryvyi Rih, Nikopol, Marganets, Sinelnikovo, Pokrov, Zhovti Vody, and other cities.

Preparation for admission to the maternity ward

A little preparation before admission makes the process easier and reduces stress. Gather the necessary documents, the maternity record (exchange card), and up-to-date test results in advance. If a trial of labor after cesarean (TOLAC) is planned, discuss hospitalization specifics with your doctor and midwife beforehand.

Documents for admission: passport, medical insurance policy, and other identification.
Maternity record (exchange card) with detailed notes on the pregnancy and information about previous deliveries.
Up-to-date test results and ultrasound scans performed at the request of your treating physician.
Medications you take regularly — bring them in their original packaging; be sure to discuss them with your doctor.
Items for the mother: basic personal belongings and essential items.
Items for the baby: a minimal set for the first hours and for feeding.
Items and documents for your partner — if their presence is planned, clarify the hospital’s requirements.
Contact phone numbers and a list of questions you want to discuss during admission.

Confirm the final list and the admission schedule with your doctor and midwife before hospitalization. This will help you feel prepared and calmer.

Conditions of the maternity ward at Genesis Dnepr

The maternity ward is organized for safe and clear management of labor, including trials of labor after cesarean (TOLAC). The team explains organizational details in advance and acts according to clinical indications in the delivery room. Below is a brief overview of the key elements to know before admission.

Delivery rooms equipped for routine care and emergency situations.
Postpartum rooms with the option for rooming-in (mother and baby together).
Cardiotocography (CTG) and the newborn’s initial assessment by a neonatologist are performed in the delivery room as standard.
Individual support by a physician and a midwife, with discussion of the plan and timely updates.
An anesthesiologist available for planned consultation and prompt involvement if needed.
Partner-supported births are offered as an organizational and medical option when there are no contraindications.
The operating room and neonatal team are prepared to rapidly change tactics if the clinical situation worsens.
Information on follow-up care and discharge conditions is provided at discharge and during the postpartum period.

Please clarify specific conditions and available options during your consultation — the team will explain organizational and clinical details in full.

When to seek urgent medical care

If you are planning a trial of labor after cesarean (TOLAC) or are simply preparing for childbirth, it’s important to recognize warning signs in time. Below are signs for which you should not wait for a scheduled appointment but should go to the maternity hospital or contact medical services immediately. Your care team will adjust actions depending on your situation.

Spotting or heavy vaginal bleeding.
Your water has broken or you notice a clear fluid leak.
Regular contractions that are increasing in intensity.
Severe or unusual abdominal or back pain.
A significant decrease or absence of fetal movements.
A sudden rise in blood pressure or a severe headache.
Visual disturbances: spots, double vision, or temporary loss of vision.
Marked weakness, fainting, or difficulty breathing.
Fever or other signs of infection.
Any sudden change in how you feel that causes you concern.

If any of these signs appear, seek help immediately. When in doubt, contact your clinic or emergency services — checking your condition will quickly relieve worry and ensure safety.

## Frequently Asked Questions

**Question:** Can I choose in advance to attempt a vaginal birth after a cesarean?
**Answer:** Often you can discuss and plan a trial of labor after cesarean (TOLAC), but the final decision depends on medical assessment and may be clarified during consultation.

**Question:** Is this type of birth suitable for everyone?
**Answer:** No, it depends on the mother’s condition, the uterine scar and other clinical factors; the physician determines suitability after examination.

**Question:** Can the birth plan be changed during labor?
**Answer:** Yes, the plan can change for medical reasons during labor; the team will explain possible scenarios in advance.

**Question:** Can I discuss the birth format before labor begins?
**Answer:** Absolutely — we recommend discussing the format, limitations and criteria for changing the plan at a scheduled consultation.

**Question:** Can I have my partner present during the birth?
**Answer:** Partnered births are possible as an organizational and medical option if there are no restrictions; check the details in advance.

**Question:** How can I prepare my partner for the birth?
**Answer:** It’s useful to discuss the partner’s role, access rules for the delivery room and possible scenarios; the doctor or midwife will advise on what to know beforehand.

**Question:** Can I use epidural anesthesia in my case?
**Answer:** Epidural anesthesia may be an option if there are no contraindications; the anesthesiologist assesses need and safety at the consultation.

**Question:** Who decides which pain relief method to use?
**Answer:** The decision is made jointly by you, the obstetrician and the anesthesiologist, taking into account the condition of the mother and baby and any contraindications.

**Question:** What if the chosen pain relief method is not suitable?
**Answer:** The analgesia plan can be adjusted during labor; if there are contraindications, alternatives or other support options will be offered.

**Question:** When is it best to go to the clinic when labor starts?
**Answer:** Come according to signs agreed with your doctor (for example, regular contractions, rupture of membranes, or worrying symptoms); clarify these criteria at your consultation.

**Question:** What should I bring to the maternity hospital?
**Answer:** Bring identification, your maternity record (exchange card), basic personal items for you and the baby, and any regular medications after consulting the doctor; check specifics with the maternity team.

**Question:** Are documents and the maternity record required?
**Answer:** Yes, the maternity record and identification are usually required for admission; also bring results of recent examinations.

**Question:** Can I come with already completed tests?
**Answer:** Yes — and it’s even advisable to bring up-to-date ultrasounds and tests, as this helps make an informed decision in advance.

**Question:** What happens if an emergency cesarean section is needed?
**Answer:** The team will promptly organize the required procedure and explain the reasons and next steps; the priority is the safety of the mother and baby.

**Question:** How long is the usual stay in the clinic after delivery?
**Answer:** The length of stay depends on the course of labor and the condition of the mother and baby; discuss approximate timelines at the consultation.

**Question:** What happens immediately after the baby is born?
**Answer:** CTG and an initial examination by a neonatologist are performed, first contact is offered and assistance with breastfeeding is provided when possible.

**Question:** What should I discuss with the doctor if I have had previous births or a cesarean?
**Answer:** Describe previous deliveries, details of the prior operation and any complications — this information is key for planning the current birth.

**Question:** Can I get a second opinion if I’m unsure about the proposed approach?
**Answer:** Yes, you can request a second opinion; the team will advise how to arrange it and what documents will be needed.