Informed Consent

Trial Of Labor After Cesarean (TOLAC)


Women who chose a trial of labor after a cesarean,

have a 70 – 80% chance of having a vaginal birth after a cesarean (VBAC).

           History of VBAC –  In 2010 ACOG (AmericanCollegeof Obstetricians & Gynecologists) set guidelines regarding a TOLAC, stating that it is a safe and appropriate choice, in the right setting, for most women who have had a previous cesarean.  Montanahas provisions for midwife attendance at a trial of labor after a cesarean (TOLAC) under rule number 24.111.612 of the Statues and Rules Relating to Direct Entry Midwives.  Pregnant women who have previously had a cesarean, who meet the criteria within the guidelines set forth below, may choose to have a trial of labor after discussion with their midwife.


*Low transverse uterine scar confirmed by operative report from the hospital, kept in prenatal record.

*Contact with a physician during the pregnancy to arrange for medical back-up, should it be needed.

*Transport plan in writing, kept in chart, including name of hospital and phone numbers.

*Birth place less than 30 minutes from the nearest hospital, able to perform an emergency cesarean.

*Fully licensed midwife, experienced in facilitating a TOLAC, able to assess true complications and emergencies, present from the onset of active labor (4 cm), throughout the immediate postpartum period.

* This informed consent for a TOLAC, signed by both parents and midwife, kept in prenatal record.

Risks of TOLAC:  Women who agree to a trial of labor after a cesarean, in appropriate situations, have a less than 1%  risk of uterine rupture. This is a rare occurrence that can quickly become catastrophic for baby and mother.  When it does occur it can lead to excessive blood loss, damage to the uterus that may require a hysterectomy. Damage to the bladder, infection, blood clots, damage or death of infant and damage or death of the mother are possibilities.  Women who choose a TOLAC, that end up with a cesarean, have a slightly higher risk of problems such as infection and hemorrhage, than women who choose a repeat cesarean.  Women who have had at least one successful vaginal birth, as well as a cesarean birth, have higher rates of successful TOLACs.  In all studies, all women with true cepahlopelvic disproportion have the lowest rate of success.

Having a TOLAC in a hospital setting may give quicker access to life-saving measures such as emergency surgery, blood transfusions and neonatal resuscitation personnel.  ACOG currently recommends that TOLACs occur in a hospital setting with access to an operating room available 24 hours a day.


The benefits of a TOLAC resulting in a successful VABC include:

*Elimination of operative and post-operative complications from a cesarean

*Shorter length of postpartum recovery

*Less risk of infection after delivery

*Easier infant care and bonding

*Birth in a familiar environment

*Greater chance of having a vaginal delivery with future pregnancies


More information can be found at:

I confirm that:

1.  I have had ______ cesarean birth (s).

2.  I have had _______ vaginal birth (s).

3. ________  I have had the opportunity to self-educate about having a TOLAC.

4. ________   I have discussed choosing a TOLAC in an out-of-hospital setting with my midwife. My questions have been answered to my satisfaction.

5. ________  My choice to have a trial of labor (TOLAC) is being made voluntarily, with careful attention to my risks and the risks to my child.


Transport plan:


Name of back-up physician: ____________________________________________


Name of facility: ________________________________________________


Address of facility:__________________________________________________________


Phone number facility: _______________________________________________________


Transportation: ________________________________________________________

Distance to facility from TOLAC location. _________________________________



Name of Birth Parent(s): ____________________________________________________


Signature / Date  ____________________________________________________________


Signature / Date  ____________________________________________________________



Midwife signature / Date  _____________________________________________________