Ethical Issues In Nursing Practice

Contemporary Issues in nursing practice Paper

TOLAC vs. elective repeat cesarean delivery

Since the early 70’s, the Western world has observed the trend of rising numbers of cesarean deliveries. In 2007 32% of all deliveries in the United Stated happened via C-section; the highest number ever. With so many cesarean deliveries many women face a dilemma regarding prospective birth. Cesarean section limits future childbirth choices, but available medical knowledge and research data overthrow the old believe: “once cesarean-always cesarean” (ACOG, 2010). In fact nowadays, many women can choose between a trial of labor after cesarean (TOLAC) and an elective repeat cesarean section. This paper will compare pros and cons of both choices and
“[sic] … however, medico-legal issues and concerns about the risk of uterine rupture have contributed to a reversal in this trend” (Amstrong, 2011) and in 2006 only 8.5% of woman successfully gave vaginal birth after previous c-section experience (ACOG, 2010). Nowadays less than 10% of mothers chooses TOLAC over elective cesarean, between 60 and 80% of them will successfully deliver their baby vaginally (VBAC). Despite great chances for successful outcomes of TOLAC many facilities and providers don’t offer their patients an option for TOLAC, pressing the expecting mothers for elective surgery. This may have been the result of earlier strict recommendations released by the ACOG in the 90’s which requiring facilities offering TOLAC to have ability of performing emergency cesarean sections on woman with failed TOLAC (James, 2010). Despite recent loosening of those strict requirements in August of 2010 many hospitals still offer repeat cesarean as the only option available. Attempting TOLAC in facilities that are not equipped for emergent situations seems very risky, as labor may quickly change its direction and put the mother and her baby at risk (situation that may arise during any labor). Additionally, attempting TOLAC at facilities that start offering it due to a change in recent recommendations seems also not
Vaginal Birth After Cesarean: New Insights. Evidence Report/Technology Assessment No.191. (Prepared by the Oregon Health & Science University Evidence-based Practice Center under Contract No. 290-2007-10057-I). AHRQ Publication No. 10-E003. Rockville, MD: Agency for Healthcare Research and Quality. March 2010.

Guise, Jeanne-Marie MD, MPH; Denman, Mary Anna MD; Emeis, Cathy PhD, CNM; Marshall, Nicole MD; Walker, Miranda MA; Fu, Rongwei PhD; Janik, Rosalind BA; Nygren, Peggy MA; Eden, Karen B. PhD; McDonagh, Marian PharmD. (2010, June). Vaginal Birth After Cesarean: New Insights on Maternal and Neonatal Outcomes. Obstetrics & Gynecology, 115(6), 1267-1278. doi:10.1097/AOG.0b013e3181df925f
James, S. (2010, June). Solving the Vaginal Birth After Cesarean Dilemma. Obstetrics & Gynecology, 155(6), 1112-1113. doi:10.1097/AOG.0b013e3181e0d1b6

Kamath, Beena D. MD, MPH1; Todd, James K. MD3; Glazner, Judith E. MS4; Lezotte, Dennis PhD4; Lynch, Anne M. MD, MSPH. (2009, June). Neonatal Outcomes After Elective Cesarean Delivery. Obstetrics & Gynecology, 113(6), 1231-1238. doi:10.1097/AOG.0b013e3181a66d57

London, M., Ladewig, P., Ball, J., & Bindler, R. (2011). Maternal and Child Nursing Care. (3rd Ed). Upper Saddle River, NJ: Pearson