Your obstetric care professional needs to know the following information:  

• The number of cesarean deliveries you have had, 

• Whether you have had any other type of surgery on your uterus (for example, to remove a fibroid), 

• The type of incisions that were made in your uterus during your cesarean deliveries or uterine surgeries, and 

• Any complications that occurred during any of these surgeries. 

This information should be available in your medical records, which your healthcare professional can help you access.  

A cesarean delivery involves two incisions: one incision in the skin of the abdomen and another incision in the uterus. The incision in the uterus can be horizontal (called a transverse incision),  vertical (called a classical incision), or a combination of the two. 

In most cesarean deliveries, a transverse incision is made across the lower part of the uterus to deliver the baby. The muscle tissue in the lower part of the uterus is thinner than in the middle part of the uterus, making the surgery easier and resulting in less bleeding.  

In a small number of cesarean deliveries, a classical incision is made in the middle part of the uterus. This type of incision may be done when a horizontal incision isn’t possible or safe. Reasons for a classical incision are to deliver a baby who is very preterm, has certain anomalies, or is not in the head-down position.   

Sometimes, a low transverse incision is made initially, but for various reasons, the incision is extended to the upper part of the uterus. This results in a T incision. If the incision is extended to the upper part of the uterus along the side of the uterus, it’s called a J incision.  

It is important to note that the type of incision made in the skin of the abdomen is not necessarily the type made on your uterus. For instance, you may have a vertical incision on your skin but a horizontal incision on your uterus. Alternatively, you may have a horizontal incision on your skin, but a vertical incision on your uterus was made to deliver your baby safely. 

A uterine rupture is a major complication in which the uterus tears or opens up during labor. It typically happens in the area of a previous uterine incision. It can cause severe bleeding and potentially life-threatening complications for both the pregnant person and the baby. The bleeding may be so severe that the uterus needs to be removed to stop the bleeding (hysterectomy). Avoiding this serious complication is why healthcare professionals recommend a planned cesarean delivery in certain situations. 

If you have had 1 prior low transverse cesarean delivery, you are a candidate for a trial of labor after cesarean delivery (TOLAC). The risk of uterine rupture is low in this situation (0.2% to 1.5%). If you are interested in a TOLAC, discuss the risks and benefits with your healthcare professional. You also need to know whether your hospital provides TOLAC. Certain safety measures need to be in place at your hospital for TOLAC to be offered, including 24/7 obstetric and anesthesia care. You should not attempt TOLAC at home or outside of a hospital. Shared decision-making with your healthcare professional will allow you to make the best-informed decision for you and your baby.  

A vaginal delivery is not recommended in these situations because there is a higher risk of uterine rupture during labor. The risk of uterine rupture is as high as 4% to 9% in people with a prior classical uterine incision. A repeat cesarean delivery should be performed, ideally before labor begins. The risk of uterine rupture, however, needs to be carefully balanced against the risks of prematurity for the baby. As a general rule, it is recommended that people with a prior classical, T, or J uterine incision undergo repeat cesarean delivery at 36 to 37 weeks of pregnancy. Your healthcare professional will review your individual circumstances to determine if the timing needs to be earlier.  

People who have had more than 2 prior cesarean deliveries are usually not candidates for a  TOLAC because they are at increased risk for several types of complications. Rather than risk a fast surgery due to complications during labor, it is best to have a planned procedure so the provider can take their time. There is also a higher risk of bleeding during delivery, which sometimes requires a blood transfusion. It is often safest to be in the operating room if a blood transfusion is needed. To minimize risks, a repeat cesarean delivery is usually recommended at 39 weeks of pregnancy. An earlier cesarean delivery may be recommended at 37 to 38 weeks of pregnancy if there were complications with the earlier cesarean deliveries or if other risk factors are present.  

The risk of uterine rupture in people with more than 1 prior cesarean delivery is between 0.9% to 3.7%. It’s unclear, however, whether this risk is higher or lower than the risk after only 1 prior cesarean delivery. In these cases, it is important to talk with your healthcare professional. Together, you can make an informed decision about the safest route of delivery for you and your baby.  

If you have had surgery to remove fibroids from your uterus (called a myomectomy), it could have affected the muscle wall of your uterus. There are different ways to remove fibroids, and each surgical approach has its own risks during pregnancy. Your healthcare professional will need to know details about your surgery, including how many fibroids were removed, how big they were, and how the surgery was done (whether through small incisions or a larger one on the uterus). Of note, this usually applies only to fibroid surgeries through your abdomen; it does not apply to fibroid surgeries done through the vagina via a surgery called hysteroscopy. In general, if your healthcare professional has recommended you have a cesarean delivery because of a prior myomectomy, it is usually done between 37 and 38 weeks of pregnancy. If your myomectomy greatly impacted your uterine muscle, delivery could be recommended earlier at 36 to 37 weeks. 

Pregnant people who have had a prior uterine rupture should not attempt a vaginal delivery because there is a high risk of uterine rupture, around 9%. Your provider will likely recommend a repeat cesarean delivery between 36 and 37 weeks of pregnancy.