Once a woman is delivered by cesarean, her options in a subsequent pregnancy are either a planned trial of labor or a planned elective repeat cesarean. There are no randomized trials comparing these two choices to definitively guide patients and physicians. The primary cesarean rate is increasing and vaginal birth after cesarean delivery (VBAC) rates are decreasing. Nonmedical factors have had a major effect on these trends. The 2010 Eunice Kennedy Shriver National Institute of Child Health and Human Development Conference on VBAC, after presenting a detailed analysis of benefits compared with risks, recommended that measures should be taken to assure women that VBAC is available to them. This will require an organized and concerted effort on the part of patients, physicians, and hospitals. To meet patient expectations for a safe and successful outcome with a trial of labor after cesarean delivery (TOLAC), specific management plans, checklists, practical coverage arrangements, and simulation drills are necessary.
A trial of labor is appropriate for many women who previously have undergone cesarean delivery.
From the Department of Obstetrics and Gynecology, University of Utah Medical Center, Salt Lake City, Utah.
See related editorial on page 199.
Continuing medical education for this article is available at http://links.lww.com/AOG/A248.
The author thanks Mary A. Hyde, MSLS, AHIP, Director of the College Resource Center, and her staff for performing the literature search.
Corresponding author: James R. Scott, MD, Department of Obstetrics and Gynecology, University of Utah Medical Center, 423 Wakara Way, Suite 201, Salt Lake City, Utah 84108-1242; e-mail: firstname.lastname@example.org.
Financial Disclosure The author did not report any potential conflicts of interest. Dr. Scott, Editor-in-Chief of Obstetrics & Gynecology, was not involved in the review or decision to publish this article.