Nurse-Midwifery M.S.

Year Approved


First Advisor

Wrede, Jane


Background/Purpose: TOLAC is the trial of labor after cesarean. VBAC is the successful birth after cesarean. The aim of this paper is to establish safety for women opting for the trial of labor after a primary cesarean. The purpose is to be able to determine how we can better counsel our women opting for TOLAC to improve the worldwide cesarean rate. Theoretical/Conceptual Framework: Imogene King’s theory of goal attainment is used to show the correlation between the patient and the midwife thorough the journey of pregnancy. The ultimate goal is to use the four paradigm’s Imogene describes to achieve a successful VBAC. Methods: Using the matrix method articles were analyzed for similar themes. The themes were then reviewed and analyzed to be able to show a commonality of success rates and the themes that were pulled out from the research. Results/Findings: Overall uterine rupture rates were between 0.38-0.9%. The use of scar dehiscence and uterine rupture for terms that indicate an emergent situation needs to be better clarified. The safety of TOLAC does not pose a higher risk to the woman than if she were to opt for a repeat cesarean section. Conclusion: Midwives need to ensure adequate teaching to women wanting a TOLAC and offer them the risks and benefits of TOLAC. Women who opt for a TOLAC rather than a repeat cesarean section will not have any higher risk imposed on them. Implications for Research and Practice: Midwives hold the key for the future of decreasing the worldwide cesarean rate, with the use of evidence-based practice we can empower women to be able to achieve a VBAC. Keywords: vaginal birth after cesarean, trial of labor after cesarean, safety of VBAC, safety of TOLAC, Imogene King’s Theory of Goal Attainment, uterine rupture, scar dehiscence, hemorrhage, NICU admissions in VBAC, NICU admissions in TOLAC.

Degree Name

M.S. Nurse-Midwifery

Document Type

Masterʼs thesis