A Unique Kind of Grief: Attempted VBAC Ending in Repeat Cesarean

When a family prepares for and attempts to have a vaginal birth after cesarean (VBAC), there is a considerable amount of thought, planning, effort, and cautious optimism that goes into the process. While the percentage of successful VBACs is high (60%-80% of women who attempt will be successful), 20-40% of women will end up having a cesarean birth after cesarean (CBAC). In a three-part series, our sister blog Science & Sensibility explores the unique grief and support needed by families who experience CBAC, of which there is little published research. While the series was written with maternity care professionals in mind, it is a helpful read for family and friends, as well as validating for new parents who have gone through this experience. I encourage you to click through and read the complete series after reading through the following summary of key points.

> Very little reseach and specific resources exist for women who experience CBAC.

"How do they feel about their experience? How is their emotional journey different than after a primary cesarean or an elective repeat cesarean? What do these women need to integrate this experience into their lives?

Anecdotally, many women report that they did not feel supported after a VBAC attempt (referred to as TOLAC - Trial of Labor after Cesarean) that ended in another cesarean. Some even felt judged or deserted by their care providers and friends. Research shows that the physical recovery is often harder, too. Yet little attention has been paid in the research to the needs of these women, and few resources exist that directly address their experiences."

> A CBAC is often experienced as more devastating than a primary (first) cesarean, leaving women to feel "broken." And yet, many women feel judged and abandoned by friends and caregivers after their CBAC birth.

'I remember after my failed [VBAC] attempt how much I needed to share my story, talk about my disappointment and sadness, and process what went wrong. But it seemed as though nobody wanted to hear it. It was almost as if my CBAC might be contagious so I should refrain from talking much about it.' Teresa Stire

> While the available research on the CBAC experience is very slim, there are a few studies that reveal helpful information on the physical and emotional recovery.

"The lesson here is that some mothers will be dealing not only with the disappointment of CBAC, but also with significant physical fallout afterwards. This can greatly complicate emotional processing, but sadly, these are often the mothers who receive the least emotional support afterwards."

"One study surveyed CBAC mothers. (Chigbu 2007) Not surprisingly, they found CBAC mothers, particularly those with no previous vaginal birth experience, often had feelings of:

• Dashed expectations
• Inadequacy as a mother
• Frustration of experiencing the pain of both labor and surgery"

> There are numerous ways friends, family, and care providers can support moms who experience CBAC. If this is your experience, consider emailing the list of suggestions (found in Part 3 of the series) to your support network.

"CBAC mothers need to have their experiences and feelings validated. Mothers need to be reminded that their hard work and accomplishments during birth are still valid, however the baby was born. Acknowledge the amazing sacrifice she made in giving up her own dreams and bodily integrity for her baby."

> CBAC resources and support groups do exist! Visit the Science & Sensibility post directly to read the complete list of resources. Share them widely!