Care for Women Desiring Vaginal Birth After Cesarean

American College of Nurse-Midwives

  • This Clinical Bulletin was developed under the direction of the Clinical Standards and Documents Section of the Division of Standards and Practice, as an educational aid for midwives. This Clinical Bulletin is not intended to dictate an exclusive course of management or to substitute for individual professional judgment. It presents recognized methods and techniques for clinical practice that midwives may consider incorporating into their practices. The needs of an individual patient or the resources and limitations of an institution or type of practice may appropriately lead to variations in clinical care.


Women with a history of a prior cesarean birth may receive conflicting information regarding options in future pregnancies related to the choice of a trial of labor after a cesarean (TOLAC) or having an elective repeat cesarean delivery (ERCD). The National Institutes of Health Consensus Development Conference on Vaginal Birth After Cesarean (VBAC) addressed questions related to safety and outcomes of having a VBAC compared to ERCD. Summary recommendations included increasing access to health care providers and facilities that care for women who desire a TOLAC yet factors were raised in determining what constitutes best practices. The purpose of this clinical bulletin by the American College of Nurse-Midwives is to offer evidence-based guidelines for midwives who are caring for women who have had a prior cesarean birth. Risk assessment, counseling, and education to support informed choices including considerations related to site of birth are provided.