When Policy Determines Practice: Consequences of Restrictions on Trial of Labor After Cesarean

Following ACOG's 1999 Practice Bulletin counseling caution regarding vaginal birth after cesarean, availability of TOLAC plummeted.

The choice between elective repeat cesarean delivery and trial of labor after cesarean (TOLAC) is driven by myriad factors, chief among them patient preference and institutional availability. In 1999, the American College of Obstetricians and Gynecologists (ACOG) recommended that TOLAC be restricted to hospitals with “immediate availability” of emergency obstetric care. Although this restriction was eased in a 2010 ACOG Practice Bulletin (NEJM JW Womens Health Aug 5 2010), following the 1999 recommendation, many hospitals had stopped offering TOLAC altogether. Investigators in New Mexico sought to determine the effect of these policy changes on availability of the service by surveying labor and delivery directors and maternity-care provider…

Author

Allison Bryant, MD, MPH

Disclosures

RoyaltiesUpToDate

Leadership Positions in Professional SocietiesSociety for Maternal-Fetal Medicine (Board of Directors)

Allison Bryant, MD, MPH

Disclosures

RoyaltiesUpToDate

Leadership Positions in Professional SocietiesSociety for Maternal-Fetal Medicine (Board of Directors)

When Policy Determines Practice: Consequences of Restrictions on Trial of Labor After Cesarean

Topics

Author