The general rule “once a cesarean always cesarean” is not based on scientific evidence. Scientific societies suggest the admission to labour for pregnant women with a history of a previous CS if there are not contraindications and in the setting where emergency CS is available.
Tolac (Trial Of Labour After Cesarean) is associated to a slight increased risk of uterine scar rupture (this risk is estimated to be approximately 47 cases over 10.000). Neonatal mortality following uterine rupture is a rare event in the reference centres (1:10.000) whereas in the birth settings not adequately equipped may reach 1.000- 2.500 cases over 10.000. Pregnant women with a previous CS admitted to labour of delivery have a lower mortality risk (3-4:100.000) than women undergoing a scheduled CS (13.4:100.000). Elective repeated cesarean section is associated to a higher blood loss, surgical complications and placental anomalies in the future pregnancies.
Ultimately the available scientific studies consider the admission to a vaginal delivery for women with a previous CS to be advantageous if the selection criteria are met and the place of birth is equipped for a safe emergency cesarean section.

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