RN Nursing · Vaginal Birth After Cesarean · Practice question
The nurse is educating a G2P1 client who had a cesarean section with her previous pregnancy due to labor dystocia and wants to have a vaginal delivery with this pregnancy. Which statement by the client indicates the need for further education regarding a trial of labor after cesarean (TOLAC)?
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"The risk of my baby dying is low."
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“There is a small chance I may experience a uterine rupture."
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"l may be a candidate for TOLAC because I have a bikini incision."
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✓
"There is no significant risk to me."
Answer & explanation
Correct: "There is no significant risk to me."
The statement that there is no significant risk to the mother indicates a need for further education. Trial of labor after cesarean carries real maternal risks, the most serious of which is uterine rupture, occurring in approximately 0.5 to 0.9% of TOLAC attempts. Uterine rupture can lead to catastrophic hemorrhage, hysterectomy, maternal death, and fetal hypoxic injury or death. Candidates for TOLAC must understand and accept these risks before proceeding. The statement that the risk of the baby dying is low is accurate; while perinatal mortality risk is slightly higher with TOLAC than with elective repeat cesarean, it remains low in appropriately selected candidates in a facility with emergency surgical capability. The statement about a small chance of uterine rupture is correct and reflects proper understanding of TOLAC counseling. The statement about being a candidate because of a bikini incision — referring to a low transverse uterine incision — is accurate; a low transverse scar carries the lowest risk of rupture and is the primary criterion for TOLAC eligibility. A classical vertical uterine incision would be a contraindication. Therefore, only the statement minimizing all maternal risk requires correction.
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