Date of Doctor of Nursing Practice Project Completion
Spring 2026
Faculty Advisor
Rebecca L. Tsusaki
Abstract
Evaluate whether implementing a structured TOLAC clinical pathway improves VBAC success, increases TOLAC attempts among eligible patients, and improves maternal and neonatal outcomes. The project was conducted at a Southeast hospital in Houston, Texas.
Women with a prior cesarean often have limited labor options because many hospitals default to repeat cesarean delivery. TOLAC remains underutilized due to safety concerns, limited provider education, and lack of standardized protocols. Evidence shows that appropriate counseling, standardized management, and close maternal–fetal monitoring can support safe vaginal birth after cesarean (VBAC).
A pre–post implementation design guided by the RE-AIM framework was used. Eligible participants included women with one prior low-transverse cesarean and singleton pregnancy ≥37 weeks. The intervention included standardized eligibility screening using the MFMU VBAC calculator, structured patient counseling, an evidence-based oxytocin protocol, and enhanced maternal–fetal monitoring. Data was collected through monthly electronic medical record chart reviews and analyzed using descriptive statistics and chi-square testing.
From May to October, TOLAC attempts ranged from 17–32 per month. VBAC success increased from 33.3% in May to 78.1% in October, while unplanned or emergent cesareans during TOLAC decreased from 66.6% to 21.8%. Documentation of TOLAC eligibility and patient consent remained 100% each month.
The pathway improved staff awareness, patient counseling, and identification of eligible patients. Challenges such as staffing shortages, pathway underuse during high-acuity shifts, maternal requests for repeat cesarean, and inconsistent documentation highlight the need for ongoing education and standardized documentation to sustain improvements.
Keywords
TOLAC, VBAC, Cesarean, Guideline, Vaginal Birth
Recommended Citation
Alexandra E. Williams, "Optimizing VBAC Outcomes Through a Structured TOLAC Pathway" (2026). Doctor of Nursing Practice Final Project Abstract. 168.
https://digitalcommons.library.tmc.edu/dnp_abstract/168