Choice of Trial of Labor after Cesarean and Association with Likelihood of Success

Abstract

Objective To investigate whether the predicted chance of success is associated with the choice to undergo trial of labor after cesarean (TOLAC). Study Design Retrospective cohort study of women with a single prior nonelective cesarean delivering a term singleton in 2012 at a tertiary care hospital. A vaginal birth after cesarean (VBAC) score (likelihood of success) was estimated for each patient. The primary outcome was percentage of women choosing TOLAC among women with favorable (> 70% likelihood) and unfavorable VBAC scores. Other factors such as desired sterilization, provider type, and spontaneous labor were included in the analysis. Results In 2012, 434 women were eligible: 73 with VBAC score >70%, and 361 with score ≤70%. Of those with score >70%, 63% chose TOLAC, compared with 21% with score ≤70% (p < 0.01). In a multivariable analysis, spontaneous labor onset was highly associated with choosing TOLAC: adjusted odds ratio 26.7 (95% confidence interval 13.86–51.29). The choice of TOLAC was also positively associated with resident provider and desired fertility. Conclusion Almost four in ten women with a history of nonelective primary cesarean and a very high predicted likelihood of VBAC choose elective repeat cesarean. Spontaneous labor was strongly associated with the choice to undergo TOLAC.