Intrapartum management of trial of labour after caesarean delivery: evidence and experience

BJOG. 2014 Jan;121(2):157-62. doi: 10.1111/1471-0528.12449. Epub 2013 Sep 16.


Few studies have focused specifically on the intrapartum management of patients following a prior caesarean delivery. Contemporary assessments and recommendations on attempting vaginal birth after caesarean delivery (VBAC) vary. The actual conduct of labour and delivery of the infant in an uncomplicated trial of labour after caesarean (TOLAC) is similar to the management of a patient without a previous caesarean. Intrapartum management of TOLAC differs primarily in the need for caution with induction of labour in women with an unfavourable cervix, the avoidance of overstimulation with oxytocin augmentation, and surveillance for prompt recognition of the rare case of uterine rupture.

Keywords: Intrapartum; TOLAC; VBAC.

Publication types

  • Review

MeSH terms

  • Anesthesia, Epidural
  • Anesthesia, Obstetrical
  • Anesthesiology
  • Cesarean Section*
  • Counseling
  • Decision Making
  • Female
  • Fetal Monitoring
  • Humans
  • Labor, Induced / adverse effects
  • Placenta Previa
  • Pregnancy
  • Trial of Labor*
  • Uterine Rupture / diagnosis
  • Uterine Rupture / etiology
  • Uterine Rupture / prevention & control
  • Vaginal Birth after Cesarean*
  • Workforce