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The Birth Blame Game

By Caitlin Clarke, DC

Why “failure language” is an infringement of birthing rights.

These are all examples of “failure language”— vocabulary that blames a birthing person, or normal variations in their anatomy or psychology, for birth not proceeding in an ideal or straightforward manner.

“Failure to progress” (FTP) (and its derivatives, such as “failure to descend,” “failure to dilate,” etc.) is perhaps the most pervasive and destructive example of failure language. What makes FTP’s ubiquitous use even more troublesome is that, since 2014, the American College of Obstetricians and Gynecologists (ACOG) has not recognized this term in its current guidelines. It is literally no longer considered a medical term. So why are so many providers still using it?

Advocates of vaginal birth after cesarean (VBAC) caution that “trial of labor” is a form of failure language. A planned VBAC isn’t an experiment. And there is no such thing as a “successful” or “unsuccessful” VBAC. There are VBACs and CBACs (cesarean births after cesareans). When CBACs are appropriate, they are a successful birth.

In the holistic birth community, we have a huge problem with psychological failure language. This occurs when doulas or midwives who are not mental health professionals blame labor patterns on emotions, fear, or a lack of “mindfulness.” It’s fine to acknowledge that emotions may be playing a role, and to explore that. But to diagnose a “psychological stall” as an excuse for failing to investigate other possibilities is dismissive and disrespectful.

Failure language also includes many widely used medical terms that need to be reexamined. In my professional circles, for instance, I encourage those of us focusing on birth passage dynamics to stop using “malposition” and say “alternative position” instead. There is nothing “mal” or “wrong” with most breech, OP, transverse, and async babies. The problem is with the inability of providers to adequately prevent alternative positions, and support these births when they do occur.

Failure language also refers to the rampant overuse and overdiagnosis of other terms and conditions.

“Stalled labor” is one ridiculously overdiagnosed situation. At births I’ve attended where the provider tosses this term around, more than half of the time it doesn’t meet ACOG’s extremely clear definition of “labor arrest.”

“Cephalic pelvic disproportion” is another, even more rare (but commonly diagnosed) condition. In most cases, a diagnosis of CPD is an unfair transfer of blame from providers who failed to focus on preventing and supporting births of alternative positioned babies. It’s easier to blame the unnecessary cesarean on the birthgiver’s “bad birthing hips.” The only way to truly diagnose CPD is advanced imaging techniques, like motion MRI, during labor. Immediate post-birth analysis of cephalic molding may also provide clues. Unless you are highly trained in these assessments, stop blaming the inadequacies of your practice and our birth culture on your patients’ anatomy.

“Failed homebirth” is the greatest misnomer of them all. There is never such a thing as a failed homebirth. An appropriate homebirth transport is always a success. Midwives are exceptionally well-trained in determining when home or a birth center is no longer a safe place for birth. Trusting that local hospital providers will collaborate professionally and support midwives and their clients is a positive thing, never a failure.

With a practice focusing on supporting VBAC, I often review records of previous births with my clients. I wish I could rewind time to the moment their provider chose to document using failure language. If they could only witness the heartbreaking effect this language has, I am sure they would discontinue its use.

Language matters. These terms burn in the minds of birthing people. They are constant accusations that they weren’t good enough. That their body failed them. That they didn’t deserve the birth they wanted. Yet none of these things are true.