Do Women Have a Choice? Nurse’s Role in Decision Making Regarding Vaginal Birth After Cesarean

Objective: Review of the current literature on the nurse’s role in women’s decision-making process, when deciding to have a vaginal birth after cesarean (VBAC) or a trail of labor after cesarean (TOLAC) is reviewed. BSN students, RNs’ play a significant role in educating and reviewing labor options, providing evidence of best outcomes for each mode of labor and risks involved when a pregnant woman is deciding on VBAC or TOLAC after a cesarean. Often a woman’s choice to undergo VBAC is not supported by their obstetric provider due to increased risk to the fetus and laboring mother. The nurse’s role is to support and advocate for the pregnant women’s selected mode of labor based on their medical history and prior deliveries. The research poster presentation briefly reviews two evidence-based guidelines supporting VBAC, nursing implications and recommended future research on this topic.

Background: One reason cesarean deliveries have increased over the last ten years is due to increased recommendations for repeat cesareans instead of a VBAC or a TOLAC. Thus, the rate of VBACS has declined due to obstetric providers’ apprehension of medical complications and risk to the fetus and laboring mother. Women who choose to have a TOLAC or a VBAC are at increased risk of uterine rupture and other outcomes. Even when their obstetrician or midwife may not agree to VBAC a nurse can educate the patient about labor options. Obstetric providers’ decision to not provide this procedure to women who have had a prior cesarean may be due to the high risk for lawsuits if there is a negative outcome for either the fetus or the mother. One recently published clinical guideline released by the American Academy of Family Physicians, Planning for Labor and Vaginal Birth after Cesarean, suggested alternative ways to appropriately care for women considering a VBAC. A nurse can make an impact in the planning process for women wanting a VBAC by providing education, support, identification of barriers, and seeking out an obstetric provider who supports this method of labor.

Methods: A review of literature was conducted on the term VBAC or TOLAC and women’s decision making about labor mode and the role of the nurse when seeking out a healthcare provider who supports this procedure. Research studies and literature were identified and reviewed on the population and variables as stated above. An integrated review of literature is presented with graphs and diagrams as appropriate and a case is made for positive labor outcomes with VBAC and supportive interventions for the women going through the process of planning for VBAC. Peer-reviewed journal articles selected were rigorous and published between 2013 and 2018.

Procedures: Identification of research design and data collection methods used in studies to evaluate the influence of care providers in decision making, the knowledge, and confidence of the women before choosing VBAC or TOLAC. In addition, positive and negative potential labor outcomes were presented on this poster.

Results: The findings from several studies indicate that women benefit from the support of an RN in the outpatient setting in evaluating their desired mode of labor after a cesarean. The nurse is an advocate, educator, and counselor for women making this important healthcare decision. Women who select a VBAC after thoroughly reviewing the risk and benefits of this procedure can make an educated and research-based decision are more pleased with their healthcare provider and quality of care.

Conclusion: Overall, the review of literature amplified the importance of supporting a woman’s decision in selecting to have VBAC or TOLAC. A nurse can make a significant contribution to the woman’s ability to make an informed decision about their delivery mode of choice.