Background/Purpose: Trial of Labor After Cesarean (TOLAC) is a safe delivery option formany women. Due to demographics, availability in rural communities, and lack of education and opportunity, many women are not attempting them. Women should have access to TOLAC regardless of their geographic location, socio-economic status, or insurance. The American College of Obstetricians and Gynecologists (ACOG) practice bulletin urges that facilities have an emergency plan in place if an emergent cesarean is required. It does not state that staff must be immediately available. Rather, it recommends that facilities provide cesarean delivery for situations that are threatening to the life of the mother or the fetus. There is no explicit definition of timing from onset of complications to delivery. The ACOG bulletins do not outlaw Vaginal Birth After Cesarean (VBAC) in hospitals that do not have 24/7 resources for emergency cesarean. Alternatively, both bulletins recommend having serious, educational discussions with the mother about the hospital’s resources, as well as the benefits and risks of VBAC. Theoretical Framework: Imogene King’s Goal Attainment theory incorporates self, perception, growth and development, space, time, interaction, communication, transaction, and coping so that we can properly care for patients (Caceres, 2015). This framework is imperative to this project because nurse-midwives work alongside women in health and pregnancy. Imogene King’s nursing theory describes an interpersonal relationship that allows people to achieve certain life goals (Nursing Theory, 2016). Nurse-midwives are the ones counseling, empowering, and guiding women to make the best decisions for them and their babies. As a nurse-midwife, the goal is to help patients find strong maternal identity during pregnancy, birth, and motherhood. Methods: 20 research articles were ultimately chosen and reviewed for their pertinence to TOLAC, VBAC, and ERCD. Results/Findings: Risks of adverse events in a TOLAC are low. The overall success rate of VBAC found in our critical literature review was 63.4-91%. This is similar to overall data reports stating success rates of 60-80%. Conclusion and Midwifery Implications: TOLAC is a safe delivery method, independent of demographics. Emergency policies and procedures should be in place. Each candidate should be carefully evaluated using a VBAC prediction tool. Risks and benefits should be weighed carefully on an individual basis.
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Kurtz, C. M., & Picker, A. R. (2019). Risks and Benefits of Trial of Labor After Cesarean When Compared to Elective Repeat Cesarean Section in Rural Facilities [Masterʼs thesis, Bethel University]. Spark Repository. https://spark.bethel.edu/etd/374