Trial of labor after cesarean and vaginal birth after cesarean section in Türkiye: According to the national clinical protocol, how applicable is it?

Öz

This review evaluates the applicability of trial of labor after cesarean (TOLAC) and vaginal birth after cesarean (VBAC) in Türkiye within the framework of the national clinical protocol, in comparison with contemporary international guidelines. Over the past half-century, increasing medicalization of childbirth and widespread use of fetal monitoring have contributed to a substantial rise in cesarean section (CS) rates, without a proportional reduction in perinatal mortality or cerebral palsy. Türkiye remains among the countries with the highest CS rates, with Robson groups involving previous cesarean deliveries (groups 5 and 10) representing a major contribution. International evidence indicates that, in appropriately selected cases, TOLAC achieves a success rate of 60–80% and is associated with a low risk of uterine rupture. Current guidelines from American College of Obstetricians and Gynecologists, Royal College of Obstetricians and Gynecologists, and International Federation of Gynecology and Obstetrics define TOLAC as a reasonable option that should be offered to most women with a prior cesarean. In contrast, the Turkish national protocol appears more restrictive and defensive, including contraindications and risk estimates that are not consistently aligned with the literature and supported by limited or outdated references. Additionally, institutional requirements for offering TOLAC are defined more stringently than in comparable guidelines. Considering the association between rising CS rates and long-term maternal and obstetric complications, strategies aimed at reducing both primary and repeat cesareans are essential. Based on current evidence, there is a clear need to revise the national protocol in Türkiye to ensure alignment with up-to-date scientific data and to promote balanced, evidence-based decision-making in TOLAC/VBAC practice.

Anahtar Kelimeler

• Trial of labor after cesarean
• vaginal birth after cesarean delivery
• cesarean section

Kaynakça

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