Healthcare Provider Education.
Each hospital had grand rounds on Trial of Labour After Caesarean (TOLAC) delivery as an introduction to the bundle. The ‘Top Practice Tips’ that came from the rounds and chart review are summarized here. Medical literature is dynamic and best practice recommendations are constantly being re-evaluated and updated. We encourage you to consult your professional society’s guideline regarding TOLAC for more information.
Society of Obstetricians and Gynecologists of Canada : No. 382-Trial of Labour After Caesarean - Journal of Obstetrics and Gynaecology Canada (jogc.com)
American College of Obstetricians and Gynecologists: Vaginal Birth After Cesarean Delivery | ACOG
Royal College of Obstetricians and Gynaecologists: gtg_45.pdf (rcog.org.uk)
Top Practice Tips to Consider in Patients Who Are Candidates for TOLAC:
An unknown uterine scar from a previous caesarean delivery is not associated with an increased risk of uterine rupture unless the indication for caesarean section was for a very premature delivery.
In patients planning a TOLAC consider a stretch and sweep every week starting at 37-38 weeks as this may decrease the need for an induction of labour.
You can consider induction of labour with a foley catheter, artificial rupture of membranes and/or oxytocin in patients with a previous caesarean.
All patients should be counselled on eligibility for TOLAC following a primary caesarean delivery.
99.5% of patients undergoing TOLAC will not have a uterine rupture.