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MMH Maternity offers Trial of Labor After Cesarean

May 17, 2019

Members of the Tender Touches Birthing Center, Maternity Unit Team,
Heather Garnder, RN, Pam Marin, RN, Charge Nurse and
Tammy Mitchell, RN, Directory of Perinatal Services

Over the last 30 years in the United States, Cesarean Section birth rates have risen. From 1970 to 2016, the rate of Cesarean Births rose from 5 percent to 31.9 percent. Though many expecting mothers have opted for a Cesarean, a number of complications can arise from giving birth this way, including uterine ruptures and dehiscence with associated maternal and/or neonatal morbidity. 

Despite these potential complications, it became common for many physicians to advise patients to deliver all subsequent babies via cesarean after first enduring a cesarean birth. By the mid-1980’s , however, some physicians began practicing what is called a Trial of Labor After Cesarean; TOLAC. In these cases expecting mothers must endure a physical, and have a comprehensive obstetric history that includes the years of previous pregnancies, the outcomes of the pregnancies, weight of the child, gestational age and other pertinent information. 

Beginning in April of 2018, Massena Memorial Hospital began advising and carrying out a TOLAC Program. In a few short months following the program’s induction, the team were seeing great results. “We had nine attempts at a trial of labor after C-section. Eight were successful and one went to the OR due to failure to progress her labor, which was why she had a section for her first delivery”, stated TammySue Mitchell, MSN, RN. 

Some of the benefits of a Vaginal Birth After Cesarean (VBAC) include a decreased rate of maternal morbidity, decreased risk of complications in future pregnancies and the added benefit of not having to recover from a surgical procedure in the postpartum period. In recent years, studies have shown that the more Cesarean births a woman goes through, the higher chance there is of obstetrical complications in the future, ranging from postpartum hemorrhaging, placenta previa and related placental disorders. “We want to provide choices that other facilities are not to our moms and in doing that provide amazing service to the family”, Mitchell said. 

In some cases, however, some women may not be candidates for a trial of labor after a cesarean birth. If a previous cesarean birth was performed with an incision made into the contractile portion of the uterus, physicians likely will recommend future cesarean births. Patients who also had previous “T” or “J” style incisions are also not likely to be considered for a VBAC birth due to the potential for a uterine rupture that may endanger the unborn child and mother. 

Ultrasounds should be utilized to best estimate the gestational age of the fetus, along with fetal heart tones being monitored during labor, in order to best decide if a VBAC is in the patients’ best interests. Spontaneous labor is also highly recommended as the success rate of a vaginal birth improves significantly, while also lowering the potential for a uterine rupture. Uterine ruptures can happen unexpectedly and in 70% of instances of a rupture, fetal heart rate is a primary indicator. In the instance that this occurs, a cesarean birth should be completed immediately to avoid compromising the fetus or quite possibly a still born fetus. 

Complications such as these can also be a danger to the mother as well. In these cases, significant hemorrhaging is possible and may require a transfusion or even a hysterectomy to save a life. But not all is doom and gloom. In fact, for expecting mothers who opt for a trial of labor after cesarean birth the success rate of a vaginal birth is well over 80% now. With proper care and precautions and regular communication with healthcare professionals, the assessment can be made whether a VBAC or Cesarean might be the best option. 

Mitchell went on to say, “We have amazing communication lines with every person who is involved in the care of our moms to be and their birth plan.  Our team is ready to go immediately if a problem arises or mom changes her mind.”  In many cases, the decision can be made to opt for a cesarean birth before labor even occurs, ensuring the safety and wellbeing of both the mother and fetus. “We want our moms to have several options when deciding to give birth.  We want them to be in control of their labor and delivery, as long as those choices are safe.” 

For more information regarding a trial of labor after cesarean birth, please visit the following: https://www.mayoclinic.org/tests-procedures/vbac/about/pac-20395249