A national survey evaluating obstetric providers’ attitudes and regional trends of trial of labor after cesarean

Abstract

Objective: To evaluate trends amongst residency programs offering trial of labor after cesarean delivery (TOLAC).Methods: An electronic survey was sent to Program Directors of every obstetrics and gynecology residency program accredited by the Accreditation Council for Graduate Medical Education (ACGME) in the USA and Puerto Rico via publicly available e-mail address for 249 of the 249 programs. The Program Directors were asked to forward the e-mail to all of the current residents in their respective program to complete a similar version of the survey.Results: Seventy-nine Program Directors (33%) and 243 residents responded. All programs offered TOLAC to patients with one prior cesarean. University programs were more likely to offer TOLAC to women with two prior cesareans compared to non-university programs (85 versus 65%; p < .01). Overall, Program Directors and residents were comfortable counseling and managing TOLACs (99 and 95%, respectively). This confidence was associated with advancing years in residency. Residents attending university programs report they are more likely to offer TOLAC to women with 1 prior cesarean (98.1 versus 91.2%, p = .02) and willing to induce TOLAC with favorable cervix (95.2 versus 88.2%; p = .03) post-residency when compared to non-university trained residents. There is an association between region and whether TOLAC is offered to women with two or more prior cesareans, without prior vaginal delivery, and women with twins. Specifically, those in the Mid-Atlantic region are less likely to offer TOLAC to women with two prior cesareans (68 versus 86%; p < .01) and those with unknown type of previous uterine incision (51 versus 74%; p < .01).Conclusion: Offering TOLAC to women with one prior cesarean appears universally acceptable amongst residency programs in the USA. Significant differences arise between types of programs and region of the country in regards to offering TOLAC to women with more complicated obstetrical histories.