Effect of stage of initial labor dystocia on vaginal birth after cesarean success

Am J Obstet Gynecol. 2015 Dec;213(6):861.e1-5. doi: 10.1016/j.ajog.2015.08.064. Epub 2015 Sep 6.


Objective: The objective of the study was to examine whether the stage of labor dystocia causing a primary cesarean delivery (CD) affects a trial of labor after cesarean (TOLAC) success.

Study design: This was a retrospective cohort study of women who had primary CD of singleton pregnancies for first- or second-stage labor dystocia and attempted TOLAC at a single hospital between 2002 and 2014. We compared TOLAC success rates between women whose primary CD was for first- vs second-stage labor dystocia and investigated whether the effect of prior dystocia stage on TOLAC success was modified by previous vaginal delivery (VD).

Results: A total of 238 women were included; nearly half (49%) achieved vaginal birth after cesarean (VBAC). Women with a history of second-stage labor dystocia were more likely to have VBAC compared with those with first-stage dystocia, although this trend was not statistically significant among the general population (55% vs 45%, adjusted odds ratio, 1.4, 95% confidence interval, 0.8-2.5]). However, among women without a prior VD, those with a history of second-stage dystocia did have statistically higher odds of achieving VBAC than those with prior first-stage dystocia (54% vs 38%, adjusted odds ratio, 1.8 [95% confidence interval, 1.0-3.3], P for interaction = .043).

Conclusion: Nearly half of women with a history of primary CD for labor dystocia will achieve VBAC. Women with a history of second-stage labor dystocia have a slightly higher VBAC rate, seen to a statistically significant degree in those without a history of prior VD. TOLAC should be offered to all eligible women and should not be discouraged in women with a prior second-stage arrest.

Keywords: labor dystocia; trial of labor after cesarean; vaginal birth after cesarean.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Cesarean Section, Repeat / statistics & numerical data
  • Cohort Studies
  • Dystocia / epidemiology*
  • Female
  • Humans
  • Labor Stage, First*
  • Labor Stage, Second*
  • Pregnancy
  • Retrospective Studies
  • San Francisco / epidemiology
  • Trial of Labor
  • Vaginal Birth after Cesarean / statistics & numerical data*