Labor progression of women attempting vaginal birth after previous cesarean delivery with or without epidural analgesia
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Normal labor curves have not been assessed for women undergoing a trial of labor after cesarean delivery (TOLAC). This study examined labor patterns during TOLAC in relation to epidural analgesia use.
Retrospective cohort study of deliveries of women undergoing TOLAC at a single, academic, tertiary medical center. Length of first, second and third stages of labor was compared between 424 women undergoing TOLAC in the current labor with no previous vaginal delivery (VD) and 357 women with at least one previous VD and current TOLAC.
Women in the TOLAC only group had significantly longer labors compared to women in the previous VD and TOLAC group. In both groups, women who underwent epidural analgesia had longer first and second stages of labor. In the TOLAC only group, more women who had epidural analgesia tended to deliver vaginally as compared to those who did not (P = 0.09). For women who delivered vaginally, the 95th percentile for the second stage duration with epidural was 3.40 h in the TOLAC only group and 2.3 h in the previous VD and TOLAC group. The 95th percentile for the second stage duration without epidural was 1.4 h in the TOLAC only group and 0.9 h in the previous VD and TOLAC group.
Operative intervention (instrumental delivery/cesarean delivery (CD)) might be considered for women attempting TOLAC after a 2-h duration of second stage without epidural and 3-h duration with epidural, with an hour less for women who also had previous VD.
KeywordsTOLAC Labor progression VBAC Epidural analgesia Labor curve
NM: data Collection, Statistical analysis, Manuscript writing. MP: data Collection, Manuscript writing. NH-Y: data collection. YD: data collection. YP: manuscript writing. TB-S: manuscript review and revision. All authors agree with the final version, as submitted.
The study was not funded.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Human and animal rights
This article does not contain any studies with human participants or animals performed by any of the authors.
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