VBAC Success Overestimated With Induction of Labor

MINNEAPOLIS — The vaginal birth after cesarean (VBAC) calculator may overestimate the likely success rate of a VBAC following induction of labor (IOL), according to research presented at American College of Obstetricians and Gynecologists (ACOG) 2025 Annual Meeting.
The VBAC calculator does not distinguish between IOL and spontaneous labor, noted Daniel Lorido, MD, MPH, of Montefiore Medical Center in the Bronx, New York, and his colleagues.
'TOLAC [trial of labor after cesarean] patients who are undergoing IOL are significantly less likely to have a successful VBAC as compared to TOLAC patients undergoing spontaneous labor,' Lorido and his colleagues concluded. 'When offering indicated or elective inductions of labor, careful, individualized counseling on the likelihood of VBAC success is essential because a failed trial of labor after cesarean may cause increased perinatal morbidity when compared to successful VBAC or scheduled repeat cesarean delivery.'
Noting that TOLAC IOL has higher rates of failure than spontaneous TOLAC, the authors sought to determine the success rate for TOLAC IOL and how it compares to spontaneous IOL and to the VBAC calculator's estimation of success for IOL.
The researchers retrospectively analyzed all cases of patients who had a history of one prior cesarean and were undergoing an IOL between January 2020 and December 2023. All 270 patients had full-term, live-born, head-first, singleton births.
Just over half the patients (51.1%) had a successful VBAC, but the VBAC calculator had predicted that 63.6% of patients would be successful ( P < .0001). The national rate of successful VBAC is 74.3%, the authors noted, but that includes both IOL and spontaneous labor. Factors associated with a successful VBAC include a history of prior vaginal delivery ( P = .0008), history of a prior VBAC ( P < .0001), and no history of arrest disorder ( P = .0007).
Specifically, 72% of patients with a prior vaginal delivery had a successful VBAC after IOL compared to 46% of patients without a previous vaginal delivery. Similarly, 82% of patients with a previous VBAC had a successful VBAC after IOL compared to 43% of patients without a previous VBAC. Among the patients who had a successful VBAC, only 22% had a history of arrest disorder.
The researchers did not find any associations between successful VBAC and age, BMI, chronic hypertension, or diabetes — even though age, weight, and treated chronic hypertension are all variables in the VBAC calculator score. Notably, the VBAC calculator was documented as a part of TOLAC counseling in only 11.39% of cases.
'In spite of these findings, we encourage offering TOLAC to all eligible patients while cautioning that accurate success rates be determined and communicated properly,' the authors wrote. 'TOLAC patients should be counseled about lower success rates of VBAC post-IOL to assist in their decision-making process.'
It's important to keep in mind when considering these findings that they are all from a single center, Audrey Merriam, MD, MS, an associate professor of obstetrics, gynecology, and reproductive science at Yale School of Medicine, New Haven, Connecticut, told Medscape Medical News .
'There may be practice patterns or preferences at this one center that could impact these results,' Merriam said. She also noted that the study was moderately sized, which also adds caution to interpretation of the findings.
That said, the study's key takeaway is that 'the VBAC calculator may not be as accurate when predicting TOLAC success for women who have had any prior cesarean delivery, not just a cesarean delivery for an arrest disorder,' Merriam said. 'The calculator is still just an estimate, so the decision to attempt a VBAC is still between the pregnant person and their physician/provider.'
While the calculator provides one piece of information for patients and providers to consider when deciding whether to attempt a TOLAC, 'ultimately, the decision is a shared decision involving risks and benefits between the patient and provider,' Merriam said.
The authors did not report receiving any external funding or having any disclosures. Merriam reported having consulted for Lily Link.

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Individuals with hypogonadism may experience: lack of development of muscle mass a voice that doesn't deepen body hair that grows sparsely impaired penis and testicular growth excessive growth of the arms and legs in relation to the trunk of the body gynecomastia menstruation that doesn't begin breast tissue that isn't developing the growth rate doesn't increase Causes of a hormonal imbalance A hormonal imbalance has many possible causes. They can differ depending on which hormones or glands are affected. 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The company LetsGetChecked provides at-home tests that have been approved by the Food and Drug Administration (FDA). However, many at-home tests have not received FDA approval. Regardless of which at-home test you choose, it is important to discuss your test results with your healthcare professional. Let them know if you're concerned about certain symptoms or a possible diagnosis. Treatment options for a hormonal imbalance Treatment for a hormonal imbalance will depend on what's causing it. Some common treatment options include: Estrogen therapy Be sure to discuss the risks and benefits of hormone replacement therapy (HRT) with your doctor. If you don't already have one, you can browse doctors in your area through the Healthline FindCare tool. Vaginal estrogen If you're experiencing vaginal dryness or pain during sex, a doctor may also recommend an estrogen cream, tablet, or ring. This local therapy helps eliminate many of the risks associated with systemic estrogen, or estrogen that travels throughout the bloodstream to the appropriate organ. Hormonal birth control Hormonal birth control can help regulate your menstrual cycles. Types of hormonal birth control include the: birth control pill birth control patch birth control shot vaginal ring intrauterine device (IUD) Some types of hormonal birth control may also help improve acne on the face and body. Anti-androgen medications Androgens are male sex hormones that are present in people of all genders. High androgen levels can be treated with medication that blocks the effects of androgens. These effects include: hair loss facial hair growth acne One androgen closely tied to hair growth and loss is testosterone. A 2020 study found that when not enough testosterone is produced, hair loss and lack of growth are common. Testosterone therapy Testosterone supplements can reduce the symptoms of low testosterone. In adolescents with delayed puberty, it stimulates the start of puberty. It's available in many forms, including injections, a patch, and gel. Testosterone replacement therapy (TRT) has risks, including to your cardiovascular system. Thyroid hormone therapy If you have hypothyroidism, the synthetic thyroid hormone levothyroxine (Levoxyl, Synthroid, Unithroid) can bring hormone levels back into balance. Metformin Metformin is a type 2 diabetes medication that may help some individuals with PCOS symptoms. The FDA has not approved it to treat PCOS, but it might help lower androgen levels and encourage ovulation. It is often prescribed off-label for this purpose. Flibanserin (Addyi) and bremelanotide (Vyleesi) Flibanserin (Addyi) and bremelanotide (Vyleesi) are the only medications that are FDA-approved for the treatment of low sexual desire in premenopausal people. Addyi is a pill, and Vyleesi is a self-administered injectable medication. 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Acne is most common in areas with many oil glands, including the: face chest upper back shoulders Acne is often associated with the hormonal changes of puberty. But there's a lifelong relationship between acne and hormones. Acne and menstruation The menstrual cycle is one of the most common acne triggers. For many individuals, acne develops the week before they get their period and then clears up. Dermatologists recommend hormonal testing for people who have acne in combination with other symptoms, such as irregular periods and excess facial or body hair. Acne and androgens Androgens contribute to acne by overstimulating the oil glands. Children of all genders have high levels of androgens during puberty, which is why acne is so common at that time. Androgen levels typically settle down in a person's early 20s. Hormonal imbalance and weight gain Hormones play an integral role in metabolism and your body's ability to use energy. 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While you can't become pregnant if you're not ovulating, irregular ovulation in PCOS can still result in pregnancy. If you're trying to become pregnant and have PCOS, your doctor may recommend methods to improve your fertility. This may include losing weight, if a doctor recommends it. Prescription medications are also available that can stimulate ovulation and increase your chances of becoming pregnant. In vitro fertilization (IVF) is also an option if medication doesn't work. As a last resort, surgery can temporarily restore ovulation. PCOS can cause issues during pregnancy for both you and your baby. There are higher rates of: gestational diabetes miscarriage preeclampsia cesarean delivery (C-section) high birth weight admission to and time spent in the neonatal intensive care unit Becoming pregnant while living with PCOS does not mean an individual will experience any of the above problems. Talking with your doctor and following their advice is the best way to have a safe pregnancy and delivery. Pregnancy and hypothyroidism Babies born to parents with untreated hypothyroidism are more likely to have developmental issues. This includes intellectual and developmental disabilities. Managing your hypothyroidism along with your doctor's advice can help lessen these risks. Hormonal imbalance and hair loss Most hair loss, such as male pattern baldness, is hereditary but may be influenced by a hormone imbalance. Hormonal changes and imbalances can also sometimes cause temporary hair loss. In AFAB folks, this is often related to: pregnancy childbirth the onset of menopause An overproduction or underproduction of thyroid hormones can also cause hair loss. Other complications Hormone imbalances are associated with many chronic, or long term, health conditions. Without proper treatment, you could be at risk for several serious medical conditions, including: type 1 and type 2 diabetes diabetes insipidus high blood pressure high cholesterol heart disease neuropathy obesity sleep apnea kidney damage depression and anxiety endometrial cancer breast cancer osteoporosis loss of muscle mass urinary incontinence infertility sexual dysfunction goiter