open dyslexic mode

PART 1: VBAC AND TOLAC

Per ACOG:
TOLAC should be attempted at facilities capable of performing emergency deliveries. The ACOG and the SMFM recommends that patients attempting TOLAC should be cared for in a level I center or higher. Level I facilities must have the ability to begin emergency cesarean delivery within a time interval that best considers maternal and fetal risks and benefits with the provision of emergency care.

The ACOG and international guidelines have recommended that resources for emergency cesarean delivery be immediately available. However, some have argued that this stipulation and the difficulty in providing required resources limit access to TOLAC especially in smaller centers with lower delivery volumes. Restricting access was not the intention of this recommendation, but much of the data concerning the safety of TOLAC is from centers capable of performing a timely emergency cesarean delivery.

Because of the risks associated with TOLAC, and because uterine rupture and other complications may be unpredictable, ACOG recommends that TOLAC be attempted in facilities that can provide cesarean delivery for situations that are immediate threats to the life of the woman or fetus. When resources for emergency cesarean delivery are not available, ACOG recommends that obstetricians or other obstetric care providers and patients considering TOLAC discuss the hospital’s resources and availability of obstetric, pediatric, anesthesiology, and operating room staff.

The decision to offer and pursue TOLAC in a setting in which the option of emergency cesarean delivery is limited should be carefully considered by patients and their obstetricians or other obstetric care providers.

Consistent with the principle of respect for patient autonomy, patients should be allowed to accept increased levels of risk; however, patients should be clearly informed of the potential increases in risk and management alternatives.

Moreover, because of the unpredictability of complications requiring emergency medical care, home birth is contraindicated for women undergoing TOLAC.

#cesarean #tolac #vbac #cesareansectionbirth

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I am a double board certified ObGyn and Maternal-Fetal Medicine specialist focusing on the care of people with maternal and/or fetal complications of pregnancy. I discuss hot topics related to fertility, pregnancy and the postpartum period, and do a little myth-busting and fact-checking to keep things real! Not only am I a doc, but I was also a patient who had infertility, a high-risk twin pregnancy and preterm delivery, and NICU stay at age 43 as a first-time mom--so I GET IT! Leave requests for new topics in comments!
 
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