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Birth. 2019 Dec;46(4):574-582. doi: 10.1111/birt.12460. Epub 2019 Nov 5.

Hospital bans on trial of labor after cesarean and antepartum transfer of care.

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Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California.
Kaiser San Francisco, San Francisco, California.
California Pacific Medical Center, San Francisco, California.
Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Evanston, Illinois.
Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts.
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.



Hospital policies restricting access to trial of labor after cesarean (TOLAC) are prevalent. Many women with a previous cesarean birth are affected by these bans, but there are limited data on the effect of these bans and whether women would consider changing delivery hospitals in the setting of a real or hypothetical TOLAC ban.


This was a survey of TOLAC-eligible women receiving prenatal care at four hospitals where TOLAC is available, and 1 non-TOLAC site. Participants were asked about their likelihood of switching hospitals to pursue TOLAC if it were unavailable. Women at the non-TOLAC site had their medical records reviewed to ascertain final location and approach to delivery.


A total of 297 women were interviewed, 48 from the non-TOLAC site. 162 (54%) participants indicated they would transfer care if TOLAC were unavailable. Among women at the non-TOLAC site, 57% who indicated an intention to switch hospitals did so. In a multivariable logistic regression model, variables associated with transferring care included race/ethnicity other than Latina (aOR 25.20 [95% CI 2.23-284.26]), being unaware of the TOLAC ban (19.81 [1.99-196.64]), and perceiving that a close friend/relative thought they should undergo TOLAC (17.31 [1.70-176.06]).


More than half of women with prior cesarean would consider transferring care if TOLAC became unavailable, and more than 1 of 3 of women at a non-TOLAC site transferred care. More research is needed on the impact of TOLAC bans and how to facilitate transfer for those who desire TOLAC.


hospital policy; trial of labor after cesarean; vaginal birth after cesarean


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