Terminology of VBAC: “Try” to “Allow” a “Trial of Labor”
By Danell Swim
January 17, 2008
A decision to give birth vaginally after a previous cesarean can be a scary one for women. The first time may have been a long labor, leading to exhaustion or fetal distress. It may have been a planned cesarean after discovering that the baby was breech or in an otherwise unfavorable birthing position. Women who have a cesarean after a labor are more likely to experience post-partum depression, and opt not to have more children. A cesarean after planning a vaginal birth can be very traumatic for the mother. So it is no surprise that women who plan a VBAC are often frightened of the coming experience. A vaginal birth is still, like a first time mother, an unknown. But more than that, a woman who has had a cesarean often knows the realities of a difficult labor and a frightening surgery. This leaves them susceptible to doubts and fear, particularly when it comes from their care provider.
Many women refer to their upcoming VBAC birth as “trying for a VBAC” or “VBAC attempt,” which makes no sense to me. The rate of a successful VBAC is about 80%. The rate of a first time mother to have a vaginal birth is also about 80%. There is no difference. And yet the medical community does not say to a first time mother “your attempted vaginal delivery.” They just assume that the mother will be able to birth the baby normally, because the odds are in her favor.
The odds are also in favor of the VBAC mother succeeding. But those are called “attempts.” This permits the doctor or midwife to keep the mother constantly worrying and aware of the possibility that she will fail. This is especially hard for a mother to hear after she has already been through one pregnancy where she was not able to birth the baby vaginally.
Next we have a “Trial of Labor,” which is what some medical institutions call a VBAC. A Trial of Labor after a Cesarean (TOLAC). Essentially, it means that they will allow the mother to have a “trial” labor, to see if she’s able to get through it. I don’t see anything wrong in calling a VBAC a VBAC. I don’t see the advantage in putting a negative spin on its name.
Every day in this nation women make the decision to have an elective repeat cesarean because their care provider will not allow them to have a VBAC. The part of this that strikes me as insane is the part where any care provider can “allow” anyone to do anything. They are saying that they have governance over these women’s bodies. In an age where women are able to make choices for themselves, because it is accepted that women make the final decisions regarding their own bodies, why is this tolerated? A doctor or midwife should never be able to decide for women. They are agents, hired by the woman, to facilitate the kind of birthing experience that the woman desires. Whether that is a cesarean or a vaginal birth, medicated or unmedicated, it is the woman’s choice in the matter. It is the woman who allows the doctor or midwife to attend her birth, not the other way around.
Care providers cannot allow you to do anything. It is your right to refuse any treatment, including a repeat cesarean.
The usage of these words has a real purpose: to strike fear, doubt and uncertainty into the mind of a pregnant woman. When obstetrician conferences have topics such as “How to Talk Women Into a Cesarean,” it shouldn’t come as a surprise. Doctors and hospitals make more money through cesareans, and to “allow” women to have a vaginal birth after a cesarean would impede the entire business.
This is not to say that all doctors and midwives, hospitals or administrators, or any individuals within the medical field are consciously striving to eliminate all vaginal births. Instead, it is a veiled idea that has propagated in the minds of these healthcare workers. It trickles down from the accountants and CEOs who see the bottom dollar, and infiltrates the dialogue of all in the industry. Until the power of this language is brought into the light, it won’t be changed. And women will continue to feel subservient to their hired professional.
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5 Responses to “Terminology of VBAC: “Try” to “Allow” a “Trial of Labor””
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Very strongly worded. I think this places more blame on the Drs and MWs than there should be, but I can see how the language would be this powerful.
I’m guessing by the first respondent’s screen name that you are a doctor? Please take what I’m about to say as no intention of disrespect. We’re all just trying to do the best we can in our own little world with whatever knowlege and experience we’ve been blessed to acquire.
Yes, this is very strongly worded, but I don’t think at all exaggerated. What part of the blame placed on doctors/midwives by this article should be redirected? And to whom? Most women are relatively clueless about childbirth, and even more deficient in knowlege of how to truly communicate with their OB about what’s important to them and what they feel is the best way to give birth. Maybe we should blame mom’s then, for not being more informed. But what about the mom’s who do thier research and know everything they should, but still manage to be strongarmed into birth choices they don’t at all feel right about simply because of policy or because of some possible risk somewhere off in the future? I know women who have been “fired” by their OB many weeks before labor is even close because they’ve refused to a schedule a repeat c-section for no medically evident reason. If a woman who knows nothing can’t get medical support for a VBAC and a woman who is highly informed can’t get medical support for a VBAC, who can? Women should not have to fight tooth and nail to just have a baby the way they were made to do it. Mother after mother has proven that VBACs are a worth the statistically small risk for those who disire one. It shouldn’t be becoming harder and harder to get one. It’s demoralizing.
gcmjaaa: You make a good point about women being strongarmed into procedures they don’t want. I think lots of doctors use the fear tactics to have their way; “it’s for the health of the baby,” “you wouldn’t want anything to happen to the baby,” “don’t put your desire for a natural/vaginal birth to get in the way of a healthy baby.” And who can argue with that? Even those of us that ARE well informed have a hard time arguing with that. *I* didn’t go to medical school, so even though I feel well informed, it’s hard to argue with someone who did. I think the main thing to remember is that we can always ask “why?” and make them show us the studies that show it’s unsafe.
Still, when most women are railroaded into this ideology of “allowing their doctor to call the shots,” it makes it harder to be confident and in charge of the birth. I guess that’s the point of the terminology… keep them so they won’t ask “Why?”
I completely agree with the article. The terminology used is a subtle way of undermining our confidence in our ability to VBAC and introduce the “likely outcome” of a repeat cesarean. I don’t think this is done intentionally by care providers, but it is certainly the result. http://www.vbacfacts.com
I AGREE 100% WITH THIS ARTICLE I AM A MOTHER WHO HAD AN UNNESSARY C-SECTION AND NOW MY DOCTOR IS PRESSURING ME INTO HAVE A REPEAT. I WOULD LOVE TO HAVE A VBAC BUT THERE ARE NO CENTERS AROUND SO NOW I HAVE TO TRAVEL AT LEAT 80 MILES JUST SO I CAN HAVE A NATURAL CHILDBIRTH. WOMEN ARE MISINFORMED ABOUT THESE KINDS OF THINGS