The Survey on Counseling and Managing Patient for Trial of Labor after Cesarean Section (TOLAC) on 2016, the survey conducted in multicenter. The questionnaire included segments on demographics data about physicians, also, elements in counselling sessions such as the success rate in case patients have previous vaginal delivery or not, the likelihood of rupture uterus, blood transfusion, endometritis maternal and fetal morbidity and mortality. Furthermore, physician preferred management in those patients if they came in spontaneous labor or need induction of labor and most frequent patient’s final decision with each physician. In total, 300 physicians working in Obstetricians and Gynecologists practice were surveyed. Data analyzed using Statistical Package for Social Sciences (SPSS) version 2; by using 95% confidence level states and a 5% margin of error.

We found that (84.91%) are including in their counseling session about successful rate of TOLAC in whom had one previous cesarean section and no previous vaginal birth (about 3 out of 4) and whom had one previous cesarean section and with at least one previous vaginal birth (almost 9 out of 10). Moreover, we discover that if patient came with spontaneous labor before an elective repeated cesarean delivery date, (81.37%) of physicians tend to prefer allowing TOLAC instead of preforming cesarean section.

Patients after having primary cesarean section in their previous pregnancies have only two route of delivery which is either vaginal birth after cesarean (VBAC) or elective repeated Cesarean delivery (ERCD). However, the final decision to choose the mode of delivery usually is made after the counselling session in the early antenatal visits with each patient and her treating physician. Unfortunately, the rate of TOLAC lately is declining. The rate of cesarean section in Kingdom of Saudi Arabia (KSA) is increasing in the last decades although World Health Organization (WHO) recommends that the rate of cesarean section should not exceed 15%. Moreover, Ministry of Health (MOH), KSA annual mortality revealed that 8% of overall maternal deaths was due to cesarean section, as a result encouraging TOLAC consider to be a safe route of delivery. Beside that we hypothesized that counselling physicians in order to misguide their patients in choosing the appropriate rout of delivery may hide some important facts that might play an important role in making the final decision of mode of delivery which include elements in counselling sessions such as the success rate in case patients have previous vaginal delivery or not, the likelihood of rupture uterus, blood transfusion, endometritis maternal and fetal morbidity and mortality.

With Regards,
Sara Giselle
Associate Managing Editor
Journal of Critical Care Obsestrics & Gynocology