title: Nonclinical factors affecting women's access to trial of labor after cesarean delivery.
abstract: The use of trial of labor after cesarean (TOLAC) has declined in the last decade, and the clinical risks of TOLAC remain low. Nonclinical factors continue to affect women's access to TOLAC. This article considers 5 categories of factors that seem to be influencing rates of TOLAC and vaginal birth after cesarean: opinion leaders and professional guidelines, hospital facilities and cesarean availability, reimbursement for providing TOLAC, medical liability, and patient-level factors. An evidence base and strategies to provide guidance to create a safe environment for vaginal birth after cesarean are needed. Obstetric information systems are critical to this effort.
authors.affiliation: Department of Obstetrics & Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA. korst@usc.edu
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Korst
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: Gregory
authors.forename: Moshe
authors.initials: M
authors.lastname: Fridman
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Phelan
mesh_terms: D001291:Attitude of Health Personnel; D017604:Cesarean Section, Repeat / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016365:Liability, Legal; D010347:Patient Care Planning; D017410:Practice Guidelines as Topic / Q000592:standards*; D011247:Pregnancy; D012307:Risk Factors; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000592:standards / Q000706:statistics & numerical data*