In a nationwide register-based analysis, women undergoing trials of labor after cesarean section (TOLACs) generally had a lower rate of labor analgesia when compared to the control group of nulliparous women. However, in terms of spinal analgesia, women with TOLACs exhibited a higher rate. Investigators sought to examine the utilization of labor analgesia in women undergoing TOLAC. Specifically, the study aimed to determine the prevalence of different labor analgesia methods among TOLAC women and compare their usage with a control group.

This study utilized data from National Medical Birth Register to assess the utilization of labor analgesia in TOLAC. The usage of labor analgesia was compared between TOLACs and pregnancies in nulliparous women. The various analgesia methods were categorized as neuraxial analgesia, paracervical, pudendal, nitrous oxide, no analgesia, other medical, and other non-medical. The analysis involved treating these categories as dichotomous variables (yes or no).

Overall, 38,596 TOLACs were identified as the second pregnancy for the mothers during the study period. The control group comprised 327,464 pregnancies in nulliparous females. Among females with TOLACs, there was a lower utilization of epidural analgesia, nitrous oxide, and non-medical analgesia. Conversely, the rate of spinal analgesia was higher in women with TOLACs in comparison with the control group (Table 1).

But, when considering only vaginal deliveries, the rate of labor analgesia escalated, particularly in the TOLAC group. These results provided valuable insights for midwives, obstetricians, and anesthesiologists, offering guidance on current practices and opportunities to enhance analgesic treatment for women undergoing TOLACs.