title: How do good candidates for trial of labor after cesarean (TOLAC) who undergo elective repeat cesarean differ from those who choose TOLAC?
abstract: OBJECTIVE
  Our aim was to compare good candidates for trial of labor after cesarean (TOLAC) who underwent repeat cesarean to those who chose TOLAC.
  
  
  METHODS
  Data for all deliveries at 14 regional hospitals over an 8-year period were reviewed. Women with a primary cesarean and 1 subsequent delivery in the dataset were included. The choice of elective repeat cesarean vs TOLAC was assessed in the first delivery following the primary cesarean. Women with ≥70% chance of successful vaginal birth after cesarean as calculated by a published nomogram were considered good candidates for TOLAC. Good candidates who chose an elective repeat cesarean were compared to those who chose TOLAC. Women who were delivered at 2 preselected tertiary centers by a general obstetrician-gynecologist practice were subanalyzed to determine whether there was an effect of physician group.
  
  
  RESULTS
  In all, 5445 women had a primary cesarean and a subsequent delivery. A total of 3120 women were calculated to be good TOLAC candidates. Of this group, 925 (29.7%) chose TOLAC. Women managed by a family practitioner or who were obese were less likely to choose TOLAC while women who were managed by a midwife or had a prior vaginal delivery were more likely to choose TOLAC. At the 2 tertiary centers, 1 general obstetrician-gynecologist group had significantly more patients who chose TOLAC compared to the other obstetrician-gynecologist physician groups (P < .001), with 63% of their patients choosing TOLAC.
  
  
  CONCLUSIONS
  Less than one-third of the good candidates for TOLAC chose TOLAC. Managing provider influences this decision.
authors: Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, UT, USA. torri.metz@dhha.org
authors: Torri D
authors: TD
authors: Metz
authors: Gregory J
authors: GJ
authors: Stoddard
authors: Erick
authors: E
authors: Henry
authors: Marc
authors: M
authors: Jackson
authors: Calla
authors: C
authors: Holmgren
authors: Sean
authors: S
authors: Esplin
mesh_terms: D000328:Adult; D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data*; D002755:Choice Behavior; D015331:Cohort Studies; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D008423:Maternal Age; D009765:Obesity; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D012189:Retrospective Studies; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data*
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