Mother knows best: An analysis of delivery modes after primary cesarean section

Abstract

Women who become pregnant after an initial cesarean section (C/S) must decide between undergoing a repeat C/S or pursuing a trial of labor after cesarean (TOLAC). The American College of Obstetricians and Gynecologists (ACOG) (2017) reported, “Despite a 23 percent increase in VBACs from 1985 to 1996, that number has since plummeted as the cesarean delivery rate has continued to trend upwards.” While many providers recommend a repeat C/S some women want to attempt a TOLAC. Those women have a 60 to 80 percent success rate of achieving a vaginal birth (ACOG, 2017). According to ACOG (2014), a VBAC can be defined as “a vaginal birth in a woman with one or more previous cesarean births” (p. 2). A repeat C/S can be defined as “. . . birth of the fetus from the uterus through an abdominal incision in a woman who had a cesarean birth in a previous pregnancy” (ACOG, 2014, p. 1). The purpose of this Evidence-Based Practice Brief is to evaluate the risk of postpartum hemorrhage based on delivery mode: VBAC as compared to a repeat C/S. Postpartum hemorrhage is defined as “cumulative blood loss > 1000 mL or bleeding associated with signs/symptoms of hypovolemia within 24 hours of the birth process regardless of delivery route” (Belfort, 2018). The information collected can be used in the nursing process for implementation, as nurses educate patients on all options of delivery (TOLAC versus repeat C/S) and advocate for patient preference.