About the Bundle

The Trial of Labour After Caesarean (TOLAC) Bundle was created and tested as a quality improvement initiative across five hospital sites in the greater Toronto area between 2018 and 2020. The bundle had three main interventions:
1. Healthcare provider education
2. Healthcare provider – patient TOLAC discussion sheet
3. Patient education resources including:
The bundle was combined with audit-and-feedback data to obstetrical staff. This included individual performance data on the rates of Elective Repeat Caesarean Delivery (ERCD) and Vaginal Birth After Caesarean (VBAC).

Research on the Bundle

The bundle has been studied in 2097 patients across 5 hospital sites in Ontario. Overall, it led to a 6% decrease in the caesarean delivery rate and a 4% increase in the induction of labour rate in patients eligible for TOLAC. There was no increased incidence of uterine rupture or NICU admission for greater than 4 hours following implementation of the bundle.
Our initial findings from the pilot site have been published in the Journal of Obstetrics and Gynecology Canada: Decreasing Cesarean Delivery Rates Using a Trial of Labour After Cesarean (TOLAC) Bundle - PubMed (nih.gov)
For a quick summary on key things healthcare providers should know about TOLAC read our “5 Things to know about Trial of Labour After Cesarean” article in the Canadian Medical Association Journal.
We have presented the bundle at multiple conferences and were a top-rated abstract at the RCOG World Congress in 2021 (#1149) Category – Hot Topics (Emerging research/issues) in Obstetrics - 2021 - BJOG: An International Journal of Obstetrics & Gynaecology - Wiley Online Library