Update: Metz (2013) came to the same conclusion of Bernstein (2012). Metz concluded, “Less than one third of the good candidates for TOLAC [trial of labor after cesarean] chose TOLAC. Managing provider influences this decision.” Read more here.
The findings of “Trial of labor after previous cesarean section versus repeat cesarean section: are patients making an informed decision?” presented at the February 9, 2012 annual meeting of the Society for Maternal-Fetal Medicine’s, The Pregnancy Meeting ™, in Dallas, Texas is not surprising. Doctors have so much influence over patients and apparently, patients are making medical decisions without a basic understanding the benefits and risks of their options.
“Even though most women can achieve a vaginal delivery with trial of labor, less than 10 percent of them attempt to do so,” said Sarah Bernstein, MD, with St. Luke’s-Roosevelt Hospital Center, Obstetrics and Gynecology, in New York, and one of the study’s authors. “In fact, when patients perceived that their doctor preferred a repeat cesarean, very few chose to undergo trial of labor, whereas the majority chose trial of labor if that was their doctor’s preference.”
The study was a survey provided to women upon admission for their elective repeat cesarean section (ERCS) or trial of labor after cesarean section (TOLAC). I am really shocked at the level of knowledge most of the women had. 73% of the women admitted for a ERCS did not know the chances of a successful VBAC and 64% did not know the risk of uterine rupture. 54% of women choosing a TOLAC did not know the chances of a successful VBAC and 45% did not know the risk of rupture! WOW!!
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.
This is why, even if you are on the fence about VBAC vs. repeat cesarean, selecting a care provider who is genuinely supportive of VBAC gives you the power of choice. Read more on what makes a supportive care provider here.
Quickly and easily provide the resources for VBAC information with the FAQ card.
Bernstein, S., Matalon-Grazi, S., & Rosenn, B. (2012). Trial of labor after previous cesarean section versus repeat cesarean section: are patients making an informed decision? Supplement to JANUARY 2012 American Journal of Obstetrics & Gynecology, S21. Retrieved from http://www.smfmnewsroom.org/wp-content/uploads/2012/01/Abstracts-27-35.pdf
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