Abstract
Objectives
To understand current attitudes and practice patterns of obstetrical care providers
regarding trial of labour after cesarean (TOLAC) and to assess misconceptions regarding
eligibility for and risks associated with TOLAC.
Methods
A survey was developed based on published literature, validated by a statistician,
and piloted with Canadian obstetricians. French and English versions were distributed
via the mailing list of the Society of Obstetricians and Gynaecologists of Canada
and social media. Practising obstetrical care providers with an office antenatal practice
were eligible to participate. Data were analyzed using descriptive statistics and
correlational and multiple regression analyses.
Results
A total of 381 people responded, with representation from every Canadian province
and territory. Obstetrician–gynaecologists (239, 63%), family physicians (100, 26%),
and midwives (42, 11%) responded. Most participants (277, 78%) thought that TOLAC
should be actively encouraged. Only 141 (40%) used a decision aid when counselling
patients, although most respondents (250, 71%) thought it would be useful. Providers
were less comfortable offering oxytocin induction compared with cervical foley or
amniotomy (P < 0.001) and offering TOLAC to patients with an unknown uterine scar (P < 0.001). Providers in western Canada reported more comfort offering TOLAC to patients
with more than 1 previous cesarean delivery compared with other regions. Two hundred
nine participants (62%) reported that they had had at least 1 patient with a uterine
rupture, with the minority of cases (13, 6%) resulting in litigation.
Conclusions
This study offers new information on current national practice patterns and provider
attitudes regarding TOLAC. These results can be used to guide future educational initiatives
to increase TOLAC rates.
Résumé
Objectifs
Comprendre les attitudes et les habitudes de pratique actuelles des fournisseurs de
soins obstétricaux en ce qui concerne l’épreuve de travail après césarienne (EDTAC)
et évaluer les idées fausses sur l’admissibilité à l’EDTAC et les risques associés.
Méthodologie
Un sondage a été élaboré à partir de la littérature publiée. Il a été validé par un
statisticien, puis piloté auprès d’obstétriciens canadiens. Les versions française
et anglaise ont été distribuées par l’entremise de la liste de diffusion de la Société
des obstétriciens et gynécologues du Canada et sur les médias sociaux. Les fournisseurs
de soins obstétricaux en exercice ayant une pratique de soins prénataux en cabinet
étaient admissibles. Les données ont été traitées par analyse statistique descriptive
et par analyse de corrélation et de régression multiple.
Résultats
Au total, 381 personnes ont répondu au sondage, et chaque province et territoire du
Canada est représenté : 239 obstétriciens-gynécologues (63 %), 100 médecins de famille
(26 %) et 42 sages-femmes (11 %). La plupart des participants (277, 78 %) sont d’avis
que l’EDTAC doit être activement encouragée. Seulement 141 personnes (40 %) disent
utiliser un outil d’aide à la prise de décision pour conseiller les patientes, mais
la plupart des répondants (250, 71 %) pensent qu’un tel outil serait utile. Les fournisseurs
de soins sont moins à l’aise d’offrir le déclenchement artificiel du travail par ocytocine
comparativement à la maturation cervicale par sonde de Foley ou à l’amniotomie (p < 0,001) et sont réticents à offrir l’EDTAC aux patientes ayant une cicatrice utérine
inconnue (p < 0,001). Les fournisseurs de soins de l’Ouest du Canada sont généralement plus à
l’aise que ceux des autres régions d’offrir l’EDTAC aux patientes ayant déjà subi
plus de 1 césarienne. Deux cent neuf participants (62 %) déclarent avoir eu au moins
1 cas de rupture utérine; une minorité de cas (13, 6 %) ont donné lieu à des poursuites.
Conclusions
Cette étude donne de nouveaux renseignements sur les habitudes de pratique nationales
actuelles et les attitudes des fournisseurs à l’égard de l’EDTAC. Ces résultats peuvent
être utilisés pour guider les futurs projets de formation pour augmenter le taux d’EDTAC.
Keywords
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Article info
Publication history
Published online: December 15, 2021
Accepted:
November 18,
2021
Received:
July 15,
2021
Footnotes
Disclosures: This study received funding from the Sinai Health Systems Quality Improvement Grant. The authors have no other real or potential conflicts of interest to declare.
Each author has indicated they meet the journal’s requirements for authorship.
Identification
Copyright
© 2021 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
