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Vaginal birth after cesarean.

J P Phelan1, S L Clark, F Diaz

  • 1Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles.

American Journal of Obstetrics and Gynecology
|December 1, 1987
PubMed
Summary
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A trial of labor after cesarean birth is safe and effective, leading to fewer maternal complications. This approach significantly reduces cesarean delivery rates, challenging the "once a cesarean, always a cesarean" policy.

Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Reproductive Health

Background:

  • Trial of labor after cesarean (TOLAC) remains a debated topic in obstetrics.
  • Previous cesarean birth (PCB) management often defaults to elective repeat cesarean sections (ERCS).
  • Evaluating the risks and benefits of TOLAC versus ERCS is crucial for optimizing maternal outcomes.

Purpose of the Study:

  • To prospectively investigate the risks and outcomes associated with a trial of labor in women with a previous cesarean birth.
  • To compare maternal morbidity and adverse events between TOLAC and non-TOLAC groups.
  • To assess the impact of TOLAC on the overall cesarean delivery rate.

Main Methods:

  • Prospective study conducted over two years (July 1982-June 1984) at a single medical center.

Related Experiment Videos

  • Inclusion criteria evolved to include women with up to two prior cesarean births after the first year.
  • Data collected on delivery mode, maternal morbidity, uterine dehiscence, and uterine rupture rates.

    • Main Results:

    • Of 2708 women with prior cesarean birth, 1796 (66%) attempted a trial of labor, with 1465 (81%) achieving vaginal delivery.
    • Successful vaginal birth rates varied by number of prior cesarean sections: 82% (one), 72% (two), 90% (three).
    • The TOLAC group experienced significantly less maternal morbidity compared to the non-TOLAC group, with similar rates of uterine dehiscence and rupture.

    Conclusions:

    • Trial of labor after cesarean birth offers significant benefits, including reduced maternal morbidity, outweighing the associated risks.
    • The study demonstrated a 54% reduction in the cesarean delivery rate for women with prior cesarean births who underwent TOLAC.
    • The findings support abandoning the strict
    • once a cesarean, always a cesarean
    • policy in favor of TOLAC when appropriate.