703: Trial of Labor after Prior Cesarean Versus Elective Repeat Cesarean: Can a Single Clinic Visit Improve Patient Knowledge about Risks and Benefits?

Relative to elective repeat Cesarean section (ERCS), trial of labor after prior Cesarean (TOLAC) is both cost-effective and associated with reduced maternal-fetal morbidity. Few eligible women choose TOLAC and the national vaginal birth after prior Cesarean rate is below 10%. Evidence suggests women make decisions regarding TOLAC with little knowledge about the risks and benefits when compared to ERCS. We hypothesized that a focused clinical counseling session would improve patient knowledge about delivery route options. We conducted an IRB approved, prospective observational study of women with a prior Cesarean and no contraindication for TOLAC who presented to our clinic for pregnancy care between Nov 2013 and July 2014. Consenting women completed a survey upon presentation for pregnancy care, again after receiving formal counseling about the risks and benefits of TOLAC versus ERCS, and once again at term. Analyses were conducted using paired t-tests. The study included 31 English- and Spanish-speaking women. Women demonstrated low baseline knowledge about TOLAC and ERCS, but knowledge significantly improved after counseling at a single clinic visit (p < 0.001) independent of primary language. For enrolled women who remained undelivered at term, knowledge about TOLAC and ERCS remained significantly elevated above baseline (p < 0.001). After counseling the frequency with which women correctly reported their own chance of successful vaginal birth was doubled (21.9% versus 43.8%). Counseling significantly improved self-reported confidence among women regarding understanding of risks associated with TOLAC. For women with a history of Cesarean birth and no contraindications for TOLAC, a durable improvement in patient knowledge about delivery routes can be achieved at a single clinic visit. Room for improvement remains, as the majority of women remained unable to estimate their chance of TOLAC success even after counseling.