Revisiting the Care Pathway for Trial of Labour After Cesarean: The Decision-to-Delivery Interval Is Key

Published:September 30, 2020DOI:


      Centres providing maternity care and offering a trial of labour after cesarean must develop and use maternal educational and consent processes that emphasize choice and autonomy related to options for and decisions surrounding vaginal birth after cesarean and elective repeat cesarean delivery. These centres should have administrative systems and processes that take into account local resources for cesarean delivery services, including team-based complex maternity risk support and an urgency consensus on the fetal, maternal, and maternal–fetal indications for a surgical delivery to ensure an appropriate decision-to-delivery interval.


      Les centres qui prodiguent des soins de maternité et offrent l’épreuve de travail après césarienne doivent mettre au point et utiliser des processus d’éducation et de consentement maternels. Ces processus doivent mettre l'accent sur le choix et l'autonomie par rapport aux options et aux décisions entourant l'accouchement vaginal après césarienne ou la césarienne itérative planifiée. Ces centres doivent avoir des systèmes et processus administratifs qui tiennent compte de la disponibilité des ressources locales pour l'accouchement par césarienne. Ces systèmes et processus doivent intégrer un soutien collaboratif en matière de risques maternels complexes et un consensus d'urgence sur les indications fœtales, maternelles et fœto-maternelles de l'accouchement chirurgicale afin d'assurer un intervalle décision-accouchement adéquat.


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        • Stirk L
        • Kornelsen J
        No. 379-attendance at and resources for delivery of optimal maternity care.
        J Obstet Gynaecol Can. 2019; 41 (e4): 688-696
        • Singh SS
        • Mehra N
        • Hopkins L
        No. 286-surgical safety checklist in obstetrics and gynaecology.
        J Obstet Gynaecol Can. 2018; 40: e237-ee42
        • Gu J
        • Karmakar-Hore S
        • Hogan ME
        • et al.
        Examining cesarean section rates in canada using the modified robson classification.
        J Obstet Gynaecol Can. 2020; 42: 757-765
        • Mei-Dan E
        • Dougan C
        • Melamed N
        • et al.
        Planned cesarean or vaginal delivery for women in spontaneous labor with a twin pregnancy: a secondary analysis of the Twin Birth Study.
        Birth. 2019; 46: 193-200
        • Hobson S
        • Cassell K
        • Windrim R
        • et al.
        No. 381-assisted vaginal birth.
        J Obstet Gynaecol Can. 2019; 41: 870-882
        • Ladhani NNN
        • Chari RS
        • Dunn MS
        • et al.
        No. 347-obstetric management at borderline viability.
        J Obstet Gynaecol Can. 2017; 39: 781-791
      1. The Healthcare Insurance Reciprocal of Canada, Canadian Medical Protective Association. Delivery in focus: strengthening obstetrical care in Canada - 10-year review of CMPA and HIROC data. Available at: Accessed on October 12, 2020.

        • Foureur M
        • Turkmani S
        • Clack DC
        • et al.
        Caring for women wanting a vaginal birth after previous caesarean section: a qualitative study of the experiences of midwives and obstetricians.
        Women Birth. 2017; 30: 3-8
        • Martel MJ
        • MacKinnon CJ
        No. 155-guidelines for vaginal birth after previous caesarean birth.
        J Obstet Gynaecol Can. 2018; 40: e195-e207
        • Dy J
        • DeMeester S
        • Lipworth H
        • et al.
        No. 382-trial of labour after caesarean.
        J Obstet Gynaecol Can. 2019; 41: 992-1011
        • Barrett JFR
        The Cochrane collaboration and the rise (and fall?) of evidence-based medicine in obstetrics.
        J Obstet Gynaecol Can. 2019; 41: S185-S1S8
        • Royal College of Obstetricians and Gynaecologists, Royal College of Anaesthetists
        Good practice no. 11: classification of urgency of caesarean section - a continuum of risk.
        2010 (Available at:)
      2. The American College of Obstetricians and Gynecologists. Cesarean birth. Frequently asked questions: labor, delivery, and postpartum care. Available at: Accessed on January 20, 2020.

        • Holmgren C
        • Scott JR
        • Porter TF
        • et al.
        Uterine rupture with attempted vaginal birth after cesarean delivery: decision-to-delivery time and neonatal outcome.
        Obstet Gynecol. 2012; 119: 725-731
        • Bujold E
        • Gauthier RJ
        Neonatal morbidity associated with uterine rupture: what are the risk factors?.
        Am J Obstet Gynecol. 2002; 186: 311-314
        • Leung TY
        • Lao TT
        Timing of caesarean section according to urgency.
        Best Pract Res Clin Obstet Gynaecol. 2013; 27: 251-267
        • Schauberger CW
        • Chauhan SP
        Emergency cesarean section and the 30-minute rule: definitions.
        Am J Perinatol. 2009; 26: 221-226
        • The American College of Obstetricians and Gynecologists
        ACOG practice bulletin no. 205: vaginal birth after cesarean delivery.
        Obstet Gynecol. 2019; 133: e110-ee27
        • Yap OW
        • Kim ES
        • Laros Jr, RK
        Maternal and neonatal outcomes after uterine rupture in labor.
        Am J Obstet Gynecol. 2001; 184: 1576-1581
        • Sentilhes L
        • Vayssiere C
        • Beucher G
        • et al.
        Delivery for women with a previous cesarean: guidelines for clinical practice from the French College of Gynecologists and Obstetricians (CNGOF).
        Eur J Obstet Gynecol Reprod Biol. 2013; 170: 25-32
        • Tsakiridis I
        • Mamopoulos A
        • Athanasiadis A
        • et al.
        Vaginal birth after previous cesarean birth: a comparison of 3 national guidelines.
        Obstet Gynecol Surv. 2018; 73: 537-543
      3. The American College of Obstetricians and Gynecologists. Safe Prevention of the Primary Cesarean Delivery. Obstetric Care Consensus. Available at: Accessed on October 12, 2020.