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Impact of obesity class on trial of labor after cesarean success: does pre-pregnancy or at-delivery obesity status matter?



To investigate whether pre-pregnancy versus at delivery obesity status impacts TOLAC success rates in a modern cohort.

Study design

A retrospective cohort study of women undergoing TOLAC at a single institution from May 2007 to April 2016. Women were divided into four groups (not obese; class I, II, and III obesity) by pre-pregnancy and at delivery weight class. We investigated associations between obesity status at both time points and TOLAC success rates.


Six hundred and fourteen women underwent TOLAC; 444 (72.3%) had successful VBACs. We found no difference in rate of VBAC success across the four groups, both prior to pregnancy (p = 0.91) and at delivery (p = 0.75). We found no differences in secondary perinatal morbidity outcomes.


We found no difference in TOLAC success rates stratified by obesity class. Properly counseling patients on TOLACs can lower rates of morbidity in women with high-risk conditions and comorbidities.

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  1. 1.

    Hamilton BE, Ventura SJ, Martin JA, Sutton PD. Preliminary births for 2004. Health E-Stats Natl Cent Health Stat. 2005;54:1–17.

  2. 2.

    Guise JM, Denman MA, Emeis C, Marshall N, Walker M, Fu R, et al. Vaginal birth after caesarean: new insights on maternal and neonatal outcomes. Obstet Gynecol. 2010;115:1267–78.

  3. 3.

    NIH Consensus Statement. Vaginal birth after cesarean: new insights. Obstet Gynecol. 2010;115:1279–95.

  4. 4.

    American College of Obstetricians and Gynecologists. Vaginal birth after cesarean delivery. Practice Bulletin No. 184. Obstet Gynecol. 2017;130:e217–33.

  5. 5.

    Cunningham FG, Bangdiwala SI, Brown SS, Dean TM, Frederiksen M, Rowland Hogue CJ, et al. NIH consensus development conference draft statement on vaginal birth after cesarean: new insights. NIH Consens State Sci Statements. 2010;27:1–42.

  6. 6.

    Institute of Medicine. Weight gain during pregnancy: reexaming the guidelines. Washington, DC: Institute of Medicine; 2009.

  7. 7.

    Bodnar LM, Siega-riz AM, Simhan HN, Himes KP, Abrams B. Severe obesity, gestational weight gain, and adverse birth outcomes. Am J Clin Nutr. 2010;91:1642–8.

  8. 8.

    Hall MJ, DeFrances CJ, Williams SN, Golosinskiy A, Schwartzman A. National hospital discharge survey: 2007 summary. Natl Heal Stat Rep. 2010;29:1–20.

  9. 9.

    Hibbard JU, Gilbert S, Landon MB, Hauth JC, Leveno KJ, Spong CY, et al. Trial of labor or repeat cesarean delivery in women with morbid obesity and previous cesarean delivery. Obstet Gynecol. 2006;108:125–33.

  10. 10.

    Chauhan SP, Magann EF, Carroll CS, Barrilleaux PS, Scardo JA, Martin JN. Mode of delivery for the morbidly obese with prior cesarean delivery: vaginal versus repeat cesarean section. Am J Obstet Gynecol. 2001;185:349–54.

  11. 11.

    Ehrenberg HM. Intrapartum considerations in prenatal care. Semin Perinatol. 2011;35:324–9.

  12. 12.

    Shanks AL, Cahill AG. Delivery after prior Cesarean: success rate and factors. Clin Perinatol. 2011;38:233–45.

  13. 13.

    Chen HY, Chauhan SP, Grobman WA, Ananth CV, Vintzileos AM, Abuhamad AZ. Association of labor induction of stimulation with infant mortality in women with failed versus successful trial of labor after prior cesarean. J Matern Neonatal Med. 2013;26:1162–5.

  14. 14.

    Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CDOC. Trends in obesity among adults in the United States: 2005 to 2014. JAMA. 2016;315:2284–91.

  15. 15.

    Landon MB, Leindecker S, Spong CY, Hauth JC, Bloom S, Varner MW, et al. The MFMU cesarean registry: factors affecting the success of trial of labor after previous cesarean delivery. Am J Obstet Gynecol. 2005;193:1016–23.

  16. 16.

    Juhasz G, Gyamfi C, Gyamfi P, Tocce K, Stone JL. Effect of body mass index and excessive weight gain on success of vaginal birth after cesarean delivery. Obstet Gynecol. 2005;106:741–6.

  17. 17.

    Durnwald CP, Ehrenberg HM, Mercer BM. The impact of maternal obesity and weight gain on vaginal birth after cesarean section success. Am J Obstet Gynecol. 2004;191:954–7.

  18. 18.

    Carroll CS, Magann EF, Chauhan SP, Klauser CK, Morrison JC. Vaginal birth after cesarean section versus elective repeat cesarean delivery: weight-based outcomes. Am J Obstet Gynecol. 2003;188:1516–22.

  19. 19.

    Isaacs JD, Magann EF, Martin RW, Chauhan SPMJ. Obstetric challenges of massive obesity complicating pregnancy. J Perinatol. 1994;14:10–14.

  20. 20.

    Yao R, Crimmins SD, Contag SA, Kopelman JN, Goetzinger KR. Adverse perinatal outcomes associated with trial of labor after cesarean section at term in pregnancies complicated by maternal obesity. J Matern Neonatal Med. 2017.

  21. 21.

    Zhang J, Troendle J, Reddy UM, Laughon SK, Branch DW, Burkman R, et al. Contemporary cesarean delivery practice in the United States. Am J Obstet Gynecol. 2010;203:326. e1–e10

  22. 22.

    ACOGObstetric Care Consensus No. 1: Safe prevention of the primary cesarean delivery. Obstet Gynecol. 2014;123:693–711.

  23. 23.

    Maykin MM, Mularz AJ, Valderramos SG, Lee LK. Validation of a prediction model for vaginal birth after cesarean delivery reveals unexpected success in a diverse American population. AJP Rep. 2017;7:941–43.

  24. 24.

    Mei JY, Havard AL, Mularz AJ, Maykin MM, Gaw SL. Impact of gestational weight gain on trial of labor after Cesarean success. Am J Perinatol. 2018.

  25. 25.

    Micek M, Kosinska-Kaczynska K, Godek B, Krowicka M, Szymusik IWM. Birth after a previous cesarean section—what is most important in making a decision? Neuro Endocrinol Lett. 2014;35:718–23.

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Author information

JYM: research study design, data collection, data analysis, manuscript preparation and edits. ALH: research study design, data analysis, manuscript preparation and edits. AJ M: research study design, data analysis, manuscript preparation and edits. MMM: research study design, data collection, manuscript preparation and edits SLG: research study design, data analysis, manuscript preparation and edits.

Conflict of interest

The authors declare that they have no conflict of interest.

Correspondence to Stephanie L. Gaw.

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