Recommendations developed for trial of labor after C-section

(HealthDay)—Recommendations have been developed for trial of labor after cesarean delivery (TOLAC) for women who wish to achieve a vaginal birth after cesarean delivery (VBAC), according to a practice bulletin published online Oct. 24 in Obstetrics & Gynecology.

William Grobman, M.D., in collaboration with the American College of Obstetricians and Gynecologists' (ACOG's) Committee on Practice Bulletins—Obstetrics, reviewed the risks and benefits of TOLAC in various clinical situations and provided guidelines for counseling and management of patients attempting VBAC.

Based on good and consistent scientific evidence, the authors write that most women with one previous cesarean delivery with a low-transverse incision are candidates for TOLAC and should be counseled accordingly. Several factors increase the likelihood of failed trial of labor, which is associated with increased maternal and perinatal morbidity versus VBAC and elective repeat cesarean delivery. Assessing the likelihood of VBAC and individual risks is important for determining who is an appropriate candidate for TOLAC. The decision to undergo TOLAC or repeat cesarean should be made by the patient in consultation with her obstetrician.

"The best circumstances for a woman to labor after having had a prior C -section is when the balance of risks and chances of success are acceptable to both the patient and the physician, and that will be different in every case," Mark Turrentine, M.D., chair of ACOG's Committee on Practice Bulletins-Obstetrics, said in a statement.

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