Healthcare practitioners' attitudes regarding trial of labour after cesarean section (TOLAC)

Objectives To understand the current attitudes and practice patterns of prenatal and intrapartum care providers regarding Trial of Labour After Cesarean Section (TOLAC) and to assess misconceptions regarding eligibility and risks of TOLAC. Methods A survey was developed based on published TOLAC literature, validated by a statistician, and piloted amongst university-affiliated faculty. French and English versions were distributed via the SOGC mailing list. Practicing obstetrical care providers with an office antenatal practice were eligible to participate. Data were analyzed using descriptive statistics, correlational and multiple regression analysis. Results The response rate was 33.7% (381/1130 eligible participants) with representation from every Canadian province and territory. Obstetricians/Gynecologists (239, 63%), Family Physicians (100, 26%) and Midwives (42, 11%) responded. Most participants (277, 78%) thought that TOLAC should be actively encouraged. Only 141 (40%) used a decision aid when counselling patients, although the majority of respondents (250, 71%) thought it would be useful. Providers were less comfortable offering oxytocin compared with cervical foley or amniotomy for induction and offering TOLAC to patients with an unknown uterine scar. Providers in Alberta and Saskatchewan reported more comfort offering TOLAC to patients with more than one previous cesarean section compared to other provinces. Two hundred and nine participants (62%) reported that they had at least one patient with a uterine rupture, with the minority (13, 6%) resulting in litigation. Conclusions This study offers new information on current national practice patterns and provider attitudes regarding TOLAC. These results can be used to guide future educational initiatives to increase TOLAC rates.