TOLAC celebrities
This celebrity underwent her 4th Cesarean delivery coining the phrase “Too Posh to Push” and brought the concept of TOLAC back to the forefront of mommy blogs and social media.
Victoria Beckham
Population that benefits the most from TOLAC - moms or babies?
Moms
Term used to describe an attempt at vaginal delivery post Cesarean delivery
Trial of labor after Cesarean (TOLAC)
Name 3 signs of uterine rupture
Continuous breakthrough pain even without contractions, NRFHT, change in station, change in presenting part
Name the two uterine incisions that are a contraindication to TOLAC.
Classical and T-shaped
This reality star has literally had every birth experience imaginable (twins, preemies, csx for breech, multiple VBACs) who knows what will be next - she is 19 kids and counting!
Michelle Duggar
Name 3 factors that make a successful TOLAC less likely
IOL, maternal obesity, post-dates, h/o dystocia, previous arrest of dilation/descent
A successful TOLAC
Vaginal birth after Cesarean (VBAC)
What do anesthesiologists recommend in a patient requesting to TOLAC?
Early epidural!
Name 2 fetal contraindications for TOLAC
Non reassuring fetal status, malpresentation
TOLAC was a cake walk compared to Rose watching Jack die in the icy Atlantic
Kate Winslet
Why is a successful TOLAC beneficial to the baby? As opposed to a planned repeat cesarean delivery.
Risk of uterine rupture after prior LTCS
~1%
Most sensitive sign of uterine rupture.
Non-reassuring fetal heart tones
Name 2 relative maternal contraindications to TOLAC
Unknown uterine scar, >1 prior uterine scar
This celeb decided to do things differently the second time around, new man, new birth plan. Much like her Almost Famous role she is a bit of a groupie
Kate Hudson
Greatest predictor for successful TOLAC
Prior vaginal delivery
Success rate of TOLAC
60-80%
Type and Screen
This medication is contraindicated in the augmentation of labor in someone attempting TOLAC
Misoprostol
This blonde backup cheerleader was feeling "GLEE"-ful after her successful VBAC.
Brittany Pierce (Heather Morris)
Name 4 of the variables included in the TOLAC nomogram based on NMH population data
Maternal age, BMI, prior vaginal delivery, prior VBAC, recurring indication for Cesarean delivery
What is it called when a patient has had two prior cesarean deliveries and now is attempting a VBAC?
TWO-lac
This is needed from an anesthesiology perspective to be able to offer a TOLAC at your hospital
Mechanism of concern with misoprostol for induction
prostaglandin that may cause thinning of the uterine scar