What is a CBAC?
The medical literature calls a cesarean that occurs during labor after a prior cesarean a “failed trial of labor,” or FTOL. This terminology is insensitive and judgmental. We are not “failures” and we did not “fail.” Nor should we be “on trial.”
Furthermore, this term judges women in an all-or-nothing, success-or-failure binary world view. The reality of birth is much more gray than that. A term was needed that reflected this.
So the term “CBAC“ was created by women in the International Cesarean Awareness Network (ICAN) as a more mother-friendly alternative. It stands for Cesarean Birth After Cesarean. This is what we call a cesarean that occurs when the mother really wanted and worked and hoped for a VBAC but didn’t get one.
When is a CBAC a CBAC?
Over the years, the women of ICAN have developed a common vocabulary around certain terms, but sometimes, terminology is clunky and inexact. Here is the meaning of “CBAC” as we commonly use it.
A CBAC does not refer to mothers who wanted to have a repeat cesarean (Elective Repeat Cesarean Section or ERCS). There is no judgment in this; women have every right to choose ERCS if they wish, and that’s perfectly fine. However, women who worked for a VBAC and didn’t get one have different emotional needs than women who wanted to have a repeat cesarean, and we need terminology to acknowledge the difference.
Most of the time, a CBAC occurs during labor. It may be early in labor, it may be in the middle of labor, or it may come after hours of pushing. The point is that a cesarean that happens after laboring with the hopes of a VBAC has a different emotional resonance than one that occurs because the mother was content to choose another cesarean.
CBAC can also refer to a cesarean performed before labor for medical reasons or because the mother had no choice. These women wanted a VBAC and may have worked very hard towards getting one, but circumstances beyond their control intervened and kept them from getting a chance to labor. Clearly, the emotional needs of these women are going to be different than a woman who was happy to have a repeat cesarean.
In addition, a woman who was coerced or scared into a planned cesarean may also decide to call her experience a CBAC. She may have wanted a VBAC desperately but may have been told that it wasn’t possible, that it was far too dangerous, or that there were no providers in the area who would “allow” VBACs. Again, the emotional needs of this woman are going to be different from the woman who wanted to have a repeat cesarean.
The important thing is that CBAC is self-defined; women get to call the experience what they prefer.
No judgment is implied towards those who choose a repeat cesarean, but use of the term CBAC acknowledges the difference in emotional impact between a cesarean that is happily chosen and one that is not wanted.
Some women prefer CSAC (Cesarean Surgery After Cesarean) or some other variation over CBAC because they do not feel their experience was a “birth.” This is another acceptable variation and is a woman’s personal choice. It is counterproductive and divisive to argue over what qualifies as a “birth” or not; the important thing is acknowledging the range of feelings that women have over their experiences.
You get to choose the term that seems right for your experience. No one has the right to tell you what term you should use.
For ease of terminology on this site, we use “CBAC” for consistency and because its meaning is intuitive compared to the word “VBAC,” but there is no judgment if you prefer a different term. The most important thing is that women use the term they prefer for themselves.