Consortium on Safe Labor

Eunice Kennedy Shriver National Institute Of Child Health & Human Development

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Abstract

In 2015, we compared spontaneous and induced labor characteristics for women with normal neonatal outcomes undergoing trial of labor after cesarean (TOLAC) who had one prior cesarean and no vaginal deliveries to nulliparous women in labor, and also compared to women who achieved vaginal delivery (e.g. having a successful vaginal birth after cesarean (VBAC)). There has been a national interest in increasing the VBAC rate in women with a prior low transverse cesarean delivery to decrease the overall cesarean rate. Duration of labor for women with one prior cesarean and no prior vaginal births undergoing TOLAC was slightly slower than nulliparous women in spontaneous labor (Grantz KL et al. American Journal of Obstetrics and Gynecology 2015). For all women undergoing TOLAC, women who spontaneously entered labor had slightly slower progress prior to 7 cm cervical dilation and women who were induced had slower progress prior to 8 cm compared to nulliparous women. Subsequently, labor progressed similarly after 7 cm and 8 cm, respectively, for both spontaneous and induced laboring women undergoing a trial of labor compared to nulliparous women. For the subgroup of women presenting in spontaneous labor who achieved vaginal delivery, the duration of labor was similar for VBAC and nulliparous women. By improved understanding of the appropriate rates of progress at different points in labor, this new information on labor curves in women undergoing TOLAC, particularly for induced labor, should help physicians when managing labor. Other areas of ongoing research include determining the optimal duration for the second stage of labor and continuing to explore how the sociodemographic changes in the current obstetrical population have affected pregnancy complications, maternal and neonatal morbidity, and implications for clinical management, including delivery timing and route.