Visit the website for the Agency for Healthcare Research and Quality (AHRQ)
at http://www.ahrq.gov/clinic/epcix.htm.
1. Locate 1 area of interest for Evidence-Based Practice in the EPC Reports
section (found under the Research tab) on the website. What does it focus on?
2. In the EBP section within the Evidence Report, what are the primary
recommendations?
Select at least 2 peers’ posts to read, and provide a thoughtful response to them. In
your replies, state whether or not you were aware of this evidence and if it is currently
being followed in your area of practice (if applicable). Feel free to post additional
resources or statements either in support of or against the evidence stated.
Your thread is due by 11:59 p.m. (ET) on Thursday, and your replies are due by 11:59
p.m. (ET) on Sunday.
Proverbs 25:2 says “It is the glory of God to conceal a matter; to search out a matter is
the glory of kings” (NIV). Evidence-based practices are the hallmark in development of
standards of care to achieve best outcomes for our patients (Mthiyane & Habedi, 2018).
Evidence-based practice is developed based on research conducted by individuals whose aim is
to improve the quality of healthcare (Mthiyane & Habedi, 2018). In my current position as a
labor & delivery nurse, my personal practice includes a plethora of evidence-based practice,
which helps me to deliver the care that my patients have a right to.
In labor & delivery, we sometimes have patients who wish to attempt a vaginal delivery
following a cesarean. This procedure is known as a trial of labor after cesarean (TOLAC). If the
vaginal birth is successful, it becomes known as a vaginal birth after cesarean, or VBAC for
short (Evans, 2014). This procedure offers many benefits including avoiding a major surgical
procedure, an increased likelihood of a shorter hospital stays, reduced risks in future pregnancies,
and overall reduced maternal mortality (Devarajan, Talaulikar, & Arulkumaran, 2018). However,
with benefits also comes risks. The major risk of TOLAC and VBAC is uterine rupture, which
becomes an obstetrical emergency and increases morbidity and mortality rates for the mother and
the neonate. Furthermore, risks can include placenta previa, placenta accrete, and higher
incidence of operative vaginal birth (Devarajan, Talaulikar, & Arulkumaran, 2018).
Due to the nature of this procedure and the wide array of risks and benefits, it becomes a
great topic for evidence-based research. The Agency for Healthcare Research and Quality report
titled “Vaginal Birth After Cesarean: New Insights” (Guise, Eden, Emeis, Denman, Marshall, et
al., 2010) is an overview of the evidence related to TOLAC and VBAC. The authors reported
that the rates of maternal morbidity and mortality were significantly increased with patients who
choose an elective repeat cesarean delivery (ERCD) over a TOLAC that leads to VBAC.
However, with both modes of delivery, there are benefits and risks. Overall, the recommendation
of the report is that a woman should discuss in detail with her physician regarding both TOLAC
and ERCD and choose which method is best for them based on medical history and preferences.
Further, the report states that TOLAC is a safe choice for most women with more evidence
related to the harm that high-order cesareans can cause.
This report offers great information for clinicians and practitioners to utilize when
discussing a patient’s options. The evidence allows hospitals and providers to develop protocols
and policies for patients who desire a TOLAC versus an ERCD. It is important that we present
all evidence to the patient, including risks, benefits, and alternatives, so that they are able to
make an informed and educated decision. With this process, we are providing the highest
standard of care for patients when we incorporate the evidence into their care. Overall, evidence-
based care is an extremely important component of providing healthcare around the world and
should be applied to all clinical situations and decisions.
References
Devarajan, S., Talaulikar, V. S., & Arulkumaran, S. (2018). Vaginal birth after
caesarean. Obstetrics, Gynaecology & Reproductive Medicine,28(4), 110-115.
doi:10.1016/j.ogrm.2018.02.001
Evans, A. T. (2014). Manual of Obstetrics(8th ed.). Philadelphia, PA: Wolters Kluwer Health.
Guise, J., Eden, K., Emeis, C., Denman, M., Marshall, N., Fu, R., . . . McDonagh, M.
(2010). Vaginal birth after cesarean: New insights(Rep. No. 191). Rockville, MD:
Agency for Healthcare Research and Quality. Retrieved June 27, 2019, from
https://www.ncbi.nlm.nih.gov/books/NBK44571/pdf/Bookshelf_NBK44571.pdf.
Mthiyane, G. N., & Habedi, D. S. (2018). The experiences of nurse educators in implementing
evidence-based practice in teaching and learning. Health SA Gesondheid,23.
doi:10.4102/hsag.v23i0.1177
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