American Academy of Family Physicians
Updating its 1995 policy, the AAFP convened a panel to systematically review the available evidence on trial of labor after cesarean delivery (TOLAC) using the Agency for Healthcare Research and Quality’s Evidence Report on Vaginal Birth After Cesarean (VBAC). The panel developed a comprehensive, evidence-based guideline for Trial of Labor After Cesarean (TOLAC), formerly Trial of Labor Versus Elective Repeat Cesarean Section for the Woman With a Previous Cesarean Section. This evidence-based clinical practice guideline is for pregnant women and their families, maternity care professionals, facilities, and policy-makers who care about trial of labor and maternity care for a woman with one previous cesarean.
The AAFP Board Chair approved this guideline as AAFP clinical policy March 2005.
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AAFP Policy on Trial of Labor After Cesarean (TOLAC)
Trial of Labor After Cesarean (TOLAC) -- A review of the evidence and recommendations from the American Academy of Family Physicians.
(20-page PDF file; About PDFs)
(20-page PDF file; About PDFs)
TOLAC Shared Patient-Physician Decision Tool -- A tool used to facilitate a conversation between a family physician and a patient who is eligible for TOLAC.
(4-page PDF file; About PDFs)
(4-page PDF file; About PDFs)
These guidelines are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute for the individual judgment brought to each clinical situation by the patient’s family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These guidelines are only one element in the complex process of improving the health of America. To be effective, the guidelines must be implemented.
