Four loaded words that may sting VBAC hopeful parents

by Jun 6, 2019Language, Planning your vbac, VBAC, VBAC Consults2 comments

Planning a VBAC can be an emotionally victorious or tenuous time for parents. Or a mixture of the two. What parents planning VBACs really need is to feel heard, supported, and respected.

The challenge is, they don’t know who to trust or to whom they can open their heart. Fortunately, there are a variety of subtle ways you can signal to them that you are someone who truly supports VBAC.

The language we use reflects what we believe. We often use words or phrases because that is what we have always done, that is how we were taught, or it is a reflection of the time and space with which we live. But sometimes, those words can hurt and sting without us even knowing.

Four loaded words that may sting VBAC hopeful parents include: “attempting,” “failed,” “TOLAC,” and “preferences.” (The word “allow” also carries a strong stench of paternalism that has no place in health care.)

“Attempting a TOLAC” is disempowering

Let’s start with the word “attempting” as in “attempting a TOLAC” or trial of labor after cesarean.

This term is used in the medical literature, so professionals and policy alike mimic this language. And as a result, these are the words parents use.

It is painful for me to hear parents talk of how they are “attempting” a TOLAC. It’s so disempowering.

The term TOLAC is filled with the feeling of “let’s see if you can really do this.” It is a word that compounds and pokes the existing swirls of emotion that some cesarean parents carry.

Hearing their provider use the term TOLAC does not make them feel supported. Rather it makes them feel like their body’s ability is being questioned and tested during this “trial” while adding a sense of worthiness and competition to their “performance.”

We can do better.

“Planning a VBAC/LAC” honors the journey

I use the phrase “planning a LAC (labor after cesarean) or VBAC” instead of “attempting a TOLAC.”

It’s my way of subversively changing the language we use around LAC.

Just like I’m not “attempting a marriage” even though divorce rates are high.

The truth is we set goals, we think about what we need to do to accomplish those goals, and we put those actions into motion.

We make plans knowing the odds, knowing that something might throw us off course, and our plans are valid regardless of how it ultimately plays out.

There is nothing passive, tentative, or powerless about that process… even though we are not in control of the outcome.

So even though no one can predict who will have a VBAC and who will have a repeat cesarean, the language surrounding labor after cesarean doesn’t need to be tentative.

Just as our support for newlyweds doesn’t need to carry a “let’s see how long you can last.”

“Failed VBAC” … it stings

When I see the word “failed VBAC,” especially written in medical studies or records, it pulls at my heart.

And again, when parents say it, when professionals say it… we aren’t talking about losing your keys. We are talking about someone’s hopes and dreams. We are talking about someone’s emotions and body.

There is so much focus – and judgement – on the outcome of a LAC rather than honoring the journey.

On top of everything else, when many parents hear “failed VBAC,” they feel like they failed. Their body failed. They are a failure. And those feelings of brokenness can percolate into other areas of their life and even haunt them in the next pregnancy.

So let’s toss the phrase “failed VBAC” or “failed vaginal delivery” from our vocabulary.

A wonderful alternative is CBAC or cesarean birth after cesarean. Or simply an unplanned (repeat) cesarean.

This language honors what the pregnant person wanted, their journey, and the outcome without judgement.

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    Birth plans, not preferences

    Now there’s a lot of things that could get in our way of accomplishing any of our goals, big or small, but we still make a plan, set the objective, and take the first step.

    Which is why parents make “birth plans” not “preferences.”

    I disagree with the notion that because we cannot control everything in regards to childbirth, parents should not make a birth plan.

    If that was our approach to life, we would never accomplish anything because the potential of our plan going off course is always there. Whether your plan is to have a happy marriage, eat less sugar, or be more patient with your kids.

    The truth is, we don’t have to be perfect – and life doesn’t have to be perfect – in order for our goals to be honored.

    Impact vs. Intentions

    Now you may be thinking, “It’s not my intention to hurt anyone. This is the language I’ve heard used, so I use it.”

    I hear you 100%.

    But here’s the hard truth: we need to focus more on the impact of our words than our good intentions.

    It really doesn’t matter if we intend to hurt someone or not. If our words or actions harm, the only recourse is to take responsibility, apologize, and change course so it doesn’t happen again.

    While this is especially difficult in situations where you would not be bothered in the least, we have to continually remind ourselves: We are not the standard to which other humans are held.

    It really doesn’t matter if you have had a cesarean and the term “attempting a TOLAC” doesn’t bother you. If it stings your client, you need to listen.

    That’s assuming that your client feels safe enough to request a language change. Many don’t. Which is why revamping your language across the board communicates to all your clients your sensitivity and desire to see, hear, and meet your clients where they are at.

    In other words, it’s not the birthing parent’s obligation to toughen up.

    It’s the responsibility of those who care for them to bring more humanity into health care.

    The fact is we have the power to change this language. Today. Right now. We don’t need anyone’s permission.

    Respect builds resilience

    We know from birthing people that if they feel respected and heard throughout the pregnancy and labor, they are more resilient if their planned labor after cesarean turns into a cesarean birth after cesarean.

    We don’t need to reiterate to them throughout their pregnancy their chances of “failure” by focusing on their “attempts” to “TOLAC” and creating a list of “preferences” instead of a plan.

    We need to use language that reflects their wishes and recognizes their journey while reinforcing your role as someone who supports their plan.

    So let’s toss “attempting a TOLAC” for “planning a LAC/VBAC.”

    Let’s replace “failed VBAC/TOLAC” for “CBAC (cesarean birth after cesarean).”

    Let’s support our clients as they create a birth plan, not preferences.

    After all, we aren’t “attempting” life.

    We are living it.


    Jen Kamel

    As an internationally recognized consumer advocate and Founder of VBAC Facts®, Jen helps perinatal professionals, and cesarean parents, achieve clarity on vaginal birth after cesarean (VBAC) through her educational courses for parents, online membership for professionals, continuing education trainings, and consulting services. She speaks at conferences across the US, presents Grand Rounds at hospitals, advises on midwifery laws and rules that limit VBAC access, educates legislators and policy makers, and serves as an expert witness and consultant in legal proceedings. She envisions a time when every pregnant person seeking VBAC has access to unbiased information, respectful providers, and community support, so they can plan the birth of their choosing in the setting they desire.

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