From the Field: Practice Guidelines for Trial of Labor after Cesarean

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PROJECT TITLE

Practice Guidelines for Trial of Labor after Cesarean (TOLAC)

NAME OF ORGANIZATION, AGENCY, OR INSTITUTION

University of North Carolina Department of Family Medicine

PRIMARY CONTACT NAME AND TITLE

Barbara A. Hotelling, Perinatal Nurse Coordinator

PROJECT AIM AND GOALS

As a Patient-Centered Maternity Home, two components of our Maternal-Child Health Care are evidence-based practice and shared decision-making. While ACOG guidelines are not always evidence-based, they have recently released guidelines allowing us all to offer trial of labor to women with two prior cesareans or twins. Our cesarean rate is 17.1% and our TOLAC success rate is 66.6%. North Carolina Medicaid is currently reimbursing cesarean birth at the same rate as vaginal birth.They were proactive in setting the rates pretty close to each other in years past.

BLUEPRINT AREA(S) ADDRESSED

STRATEGIES USED

FOR MORE INFORMATION

Barbara A. Hotelling, bhotelli@unch.unc.edu

Filed in Clinical controversies, Clinical practice guideline/policy change, New care delivery model, Performance measurement/reporting, Scope of covered services, Shared decision making, Stories from the Field on Tue., Sep 20, 2011

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