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31: Trial of labor after previous cesarean section versus repeat cesarean section: are patients making an informed decision?

      Objective

      Although trial of labor after cesarean (TOLAC) is considered a reasonable option for most women, with an overall rate of success of 60-80%, the majority of women who would be eligible for a TOLAC undergo an elective repeat c-section (ERCS).We hypothesized that this is due, in large part, to poor education of patients on the risks and benefits of both options.

      Study Design

      We conducted an IRB approved, prospective observational study of women who presented to our hospital for delivery between November 2010 and July 2011 with a history of one prior c-section and no contraindications for TOLAC. Consenting women were asked to fill out a questionnaire upon presentation to labor and delivery, either prior to their scheduled ERCS or upon admission for their TOLAC. Chi-Square and t-test were used,as appropriate,with Bonferroni correction for multiple comparisons.

      Results

      The study included a total of 155 women, 87 that presented for TOLAC and 68 that presented for ERCS. There were no differences in age, level of education, ethnicity and provider type between the groups. Women in both groups demonstrated lack of knowledge on the risks and benefits of TOLAC and ERCS, particularly women in the ERCS group. Specifically, patients were not familiar with the chances of a successful TOLAC, the effect of indication for previous CS on success, the risk of uterine rupture, and the increase in risk with each successive CS. Only 13% of TOLAC patients and 4% of ERCS patients knew the chances for a successful TOLAC, while the majority in both groups stated that they “did not know”. The majority (64%)of ERCS patients did not know the risk of uterine rupture during TOLAC and 52% did not know which delivery mode had a faster recovery time. When patients perceived their providers as having a preference for ERCS, only 4% chose TOLAC. Conversely, 43% chose TOLAC when they thought that was their provider's preference.

      Conclusion

      Candidates for TOLAC appear to have little knowledge of the risks and benefits associated with their choice for mode of delivery and provider preference affects this choice, either directly or indirectly.
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