Outcomes Associated with a Trial of Labor After Cesarean Section (2017)

Objective: To examine the outcomes of women attempting a trial of labor after cesarean section (TOLAC). Methods: A retrospective chart review was performed on all patients who attempted a TOLAC from June 2012 to May 2016 at John Peter Smith Hospital (JPS). Delivery characteristics and prevalence of adverse delivery outcomes were assessed and then compared to a previous TOLAC study at JPS (2004-2008). Stratified analysis was performed and statistical significance was calculated with χ2 and fishers exact statistics (α Results: 660 patients attempted a trial of labor during the study period. This was 2% of the total births at the hospital during the time period. 444/660 delivered vaginally (67%). Successful VBAC was significantly more likely when the patient presented in spontaneous labor versus when the patient was induced (74% vs 49%, p= Conclusions: The overall success rate of 67% is within the expected range based on public data. However, the success rate at JPS Hospital had decreased from the previous study. This decrease in success coincides with an increase in the rate of induction of labor. Indeed, the success rates for patients who are induced is lower than the patients who present in spontaneous labor. Based on this data, we will reevaluate our practice of induction of labor in trial of labor candidates.