Impact of Education on Trial of Labor After Caesarean Section

The utilization of cesarean deliveries in the United States has remained constant since 2012, at a rate of approximately one third of all deliveries. The over-utilization of medically unnecessary cesareans presents a significant public health problem, as disparities in cesarean deliveries are related to higher maternal and infant morbidity. Research shows that attempt at trial of labor after cesarean (TOLAC) in eligible candidates is positively correlated with patient education on the associated risks and benefits, as well as physician preference.  The purpose of this study is to analyze and compare the impact of education on attempt at TOLAC and on physician support. A comprehensive review of the literature was conducted to identify current educational initiatives that aim to increase knowledge about the benefits and risks of TOLAC. The identified initiatives were evaluated based on program size, type of educational aid, educational target (patients and/or physicians), success at increasing TOLAC in eligible candidates, and potential for replication. Findings suggest that educating patients and physicians on the benefits of vaginal birth after cesarean (VBAC) results in increased TOLAC rates in women. It is our recommendation that a standardized educational aid should be adopted and promoted by the American College of Obstetrics and Gynecology (ACOG).