Statistically speaking you are more likely to have a CBAC (Caesarean Birth After Caesarean) than a VBAC (Vaginal Birth After Caesarean). [To see where these statistics come from, please click HERE] Sadly this leaves many women feeling as if they failed but the truth is that birth isn’t a test and women don’t fail at it. Ever.
When a woman plans a VBAC and it ends in CBAC then one of two things has happened. Either her support team and care provider have failed her, or a caesarean has become medically necessary.
It is not a“failed VBAC” when surgery is life-saving (or humane) it is a successful caesarean. It is the appropriate application of medical technology and skills to protect a woman and baby from a less than optimal outcome. It’s crucial to acknowledge that birth grief can accompany a necessary caesarean, but the word “fail” is poorly suited to this situation.
There’s a saying in the obstetric world: “the only caesarean you get sued for is the one you didn’t do”. For care providers there is a professional risk in VBAC. So midwives and surgeons have an undisclosed financial and professional interest in repeat surgery. It means that they often err on the side of extreme caution, or that they deliberately and aggressively sabotage a VBAC attempt.
A heavily pregnant, labouring woman is not at fault for the actions of others, nor is she at fault for trusting the people she employed to care for her. Abuse of trust and power is wrong, there is never a valid excuse to mislead a trusting woman.
Women need really solid support when they are are in labour, they need whoever they’ve invited into their birth space to be fully present. If a support person becomes tired, or frightened, or impatient and a repeat caesarean follows, the woman has not failed, the supporter has. This doesn’t mean that they are evil, but it does suggest that they were ill prepared for the intensity of the job they were undertaking, or that they underestimated the importance of it.
Poorly prepared support teams and unsupportive care providers frequently team up, wittingly or unwittingly, to create the perfect conditions for CBAC. A labouring woman is extremely suggestible. The subtlest hint from anyone, the slightest wobble in support can lead directly to theatre.
It is not the woman’s job to stand strong, never wavering in the throes of birth. It is the job of the care provider and the support team to adequately reassure her, to help her achieve her VBAC, and never to use her vulnerability for their own advantage.
Birth doesn’t happen in some vortex where only women are responsible for the outcome, but at the end of the day it’s always women who take ownership of the burden. It’s wholly unfair that women take on not only the physical ardours of healing, but the emotional fallout too. All too often women blame themselves for the actions of others.
It’s good to seek an understanding of personal responsibility in any situation where grief or trauma are present. That goes without saying. But what is often unsaid is that it’s also necessary to apportion blame to those who failed at their supporting roles, in a personal or professional capacity. Remember that all choices are not equal, and when options are limited by the unspoken motives of others the labouring women is never responsible for an unnecessary caesarean.
Blame is not a dirty word, if you blame a doctor or your husband for your CBAC you are not a bad person. Letting a vulnerable pregnant woman down is something that people should be held accountable for! If someone failed to provide adequate support or they lied and manipulated you into unnecessary surgery, then they must carry the burden of that. Women with birth trauma or grief should not be angry at themselves for the behaviour of others.
Acceptance comes from truly understanding the myriad of factors that go into a CBAC, not from self hatred. When a caesarean replaces a longed for vaginal birth many women grieve and nothing can trap a woman in her grief quite like misdirected beliefs about fault and failure. Women do not fail at VBAC. Sometimes unwanted, traumatic caesareans are necessary for valid health reasons, and sometimes care providers or support teams fail at VBAC, but not women.