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. This is an opportunity to be intentional with language.
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 phrases that may sting VBAC hopeful parents include language like: "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 throughout in the medical literature, so professionals and policy alike use it. And as a result, this is the language 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 some parents 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 phrases "planning a LAC (labor after cesarean)" or "planning a 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."
Planning a VBAC focuses on the intention, to labor, rather than the outcome, where the baby exits the body. It honors the process.
"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. We are talking about something that impacts the risks in future pregnancies. We are talking about something that may determine choices around family size. We are talking about long term health outcomes.
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.
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 get 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
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About Jen Kamel
founder of VBAC Facts®️
Jen Kamel is the CEO and Founder of VBAC Facts® Since 2007, her focus has been to provide objective, accurate information about the data available on VBAC and repeat cesarean to parents, professionals, policymakers, and the court so all decisions can be informed, ethical, and just. VBAC Facts® works to achieve this mission through their educational courses for parents, online membership for professionals, continuing education trainings, and consulting services.
As an internationally recognized consumer advocate, Jen speaks at conferences across the world, 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.
VBAC Facts® 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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