EC Gynaecology

We present a case of multiparous a woman, followed in a peripheral maternity of less than 1000 birth/year, in Belgium. This G5P3 patient was willing to give birth naturally despite two previous cesarean. She already had a successful vaginal delivery for her third child the patient wanted to experimented, for whom she made the choice to give birth at home followed by a midwife and not in a medical institution. In this context we allowed the trial of labor. After a spontaneous labor she gave birth vaginally without complications.

With this case we discuss the condition of access to trial of labor after cesarean - TOLAC, for woman who have two previous cesarean. Despite the international guidelines, in our country there is only a few women with two cesarean to attempt vaginal delivery. For the majority of them they have planned cesarean and are not allowed to attempt TOLAC. However, the chance of successful vaginal delivery are high even with more than one cesarean and the risk of uterine rupture is similar to the risk expected with one previous cesarean. Extend the offer of TOLAC to women with two previous cesarean could contribute to reduce the rate of cesarean, its complications and cost. Nevertheless, the safety of vaginal delivery is still a concern and those women should be followed in medical institution than can provide emergency medical care.

Keywords: TOLAC; Cesarean Section; Vaginal Delivery

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