VBAC Trial of Labor Informed Consent

# VBAC Trial of Labor Informed Consent > **Important — not medical advice.** For use by a licensed provider; tailor to the patient, your protocols, and state law. **Patient Name:** ___________ **Date of Birth:** ___________ **Medical Record Number:** ___________ **Estimated Due Date:** ___________ **Number of Prior Cesarean Deliveries:** ___________ **Prior Uterine Incision Type (if known):** ___________ **Ordering Provider:** ___________ --- ## 1. Procedure I, the undersigned patient, consent to a **trial of labor after cesarean (TOLAC)** with the goal of achieving a **vaginal birth after cesarean (VBAC)** under the care of my healthcare team. A trial of labor after cesarean means I will attempt to labor and deliver vaginally rather than undergoing a scheduled repeat cesarean section. Continuous electronic fetal monitoring will be used throughout my labor. Intravenous (IV) access will be established and maintained throughout labor. My care team will be prepared at all times to perform an emergency cesarean section if needed. --- ## 2. Indication / Eligibility I have been assessed by my provider and determined to be an appropriate candidate for TOLAC based on the following: **Eligibility factors confirmed:** ___________ Standard eligibility criteria for TOLAC include: one prior low-transverse uterine incision, singleton pregnancy in vertex (head-down) presentation, gestational age ≥37 weeks, no other uterine surgery contraindications, and delivery at a facility with immediate cesarean capability and in-house anesthesia. --- ## 3. Benefits