Trial of labor versus repeat cesarean: are patients making an informed decision?

Am J Obstet Gynecol. 2012 Sep;207(3):204.e1-6. doi: 10.1016/j.ajog.2012.06.057. Epub 2012 Jul 4.


Objective: Most women eligible for a trial of labor after a cesarean (TOLAC) undergo an elective repeat cesarean section (ERCS). We hypothesized that this is largely because of poor patient education.

Study design: This was a prospective study of women who presented to our hospital from November 2010 through July 2011 who were candidates for TOLAC. Women filled out a questionnaire prior to their scheduled ERCS or upon admission for TOLAC. A χ(2) and a Student t test were used, as appropriate.

Results: The study included 155 women, 87 for TOLAC and 68 for ERCS. Women in both groups demonstrated a lack of knowledge on the risks and benefits of TOLAC and ERCS. When patients perceived their providers as having a preference for ERCS, very few chose TOLAC, whereas the majority chose TOLAC if this was their provider's preference.

Conclusion: Candidates for TOLAC appear to know little about the risks and benefits associated with their mode of delivery, and provider preference affects this choice.

MeSH terms

  • Adolescent
  • Adult
  • Cesarean Section, Repeat*
  • Choice Behavior*
  • Female
  • Humans
  • Informed Consent*
  • Patient Education as Topic*
  • Pregnancy
  • Prospective Studies
  • Surveys and Questionnaires
  • Trial of Labor*
  • Young Adult