Vaginal birth after Cesarean

Appropriate candidates

Hx 1-2 C-section via low transverse hysterotomy. 

Inappropriate candidates

Previous classical or T-incision, prior uterine rupture, extensive transfundal uterine surgery (ex: myomectomy), and patient with any contraindication to vaginal delivery.

Online NICHD VBAC success rate calculator

Delivery Considerations

• Misoprostol should NOT be used for TOLAC induction given elevated risk of uterine rupture
• Continuous fetal monitoring should be employed
• Maintain high suspicion for signs/sx of uterine rupture, including new onset uterine pain, loss of fetal station, new fetal heart race tracing abnormalities (most common), vaginal bleeding and maternal hemodynamic instability
• Staff (OB and anesthesia) must be immediately available for emergent c-section

Pocket Obstetrics and gynecology by K Joeph Hurt 2nd edition