Racial and Ethnic Disparities Among Women Undergoing a Trial of Labor After Cesarean Delivery: Performance of the VBAC Calculator with and without Patients’ Race/Ethnicity

Buckley, Ayisha; Sestito, Stephanie; Ogundipe, Tonia; Roig, Jacqueline; Rosenberg, Henri; Cohen, Nissim; Wang, Kelly; Stoffels, Guillaume; Janević, Teresa; DeBolt, Chelsea A.; Cabrera, Camila; Cochrane, Elizabeth; Berkin, Jill; Bianco, Angela; Vieira, Luciana

doi:10.1007/s43032-022-00959-2

Cited by 9 publications

(6 citation statements)

References 8 publications

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“…[10][11][12][13][14][15][16][17] Simultaneously, the use of Black "race" as a risk factor in medicine is being challenged across various health outcomes. [18][19][20][21] Accordingly, the intention of this article is to encourage a paradigm shift in our causal frameworks, one that embraces anti-racist thinking and praxis by recognizing the harm and limitedness of maintaining a race-based paradigm that labels Black "race" as the risk factor and instead names anti-Black racism as the root cause of these persistent disparities, thereby revealing important and highly treatable pathways (Fig. 1).…”

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confidence: 99%

Why Causation Matters

Mayne,

Buckley,

Ghidei

2023

Obstetrics &Amp; Gynecology

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Although it is tempting to construe the correlation between Black “race” and higher rates of preterm birth as causal, this logic is flawed. Worse, the continued use of Black “race” as a risk factor for preterm birth is actively harmful. Using Black “race” as a risk factor suggests a causal relationship that does not exist and, critically, obscures what actually causes Black patients to be more vulnerable to poorer maternal and infant outcomes: anti-Black racism. Failing to name anti-Black racism as the root cause of Black patients' vulnerability conceals key pathways and tempts us to construe Black “race” as immutably related to higher rates of preterm birth. The result is that we overlook two highly treatable pathways—chronic stress and implicit bias—through which anti-Black racism negatively contributes to birth. Thus, clinicians may underuse important tools to reduce stress from racism and discrimination while missing opportunities to address implicit bias within their practices and institutions. Fortunately, researchers, physicians, clinicians, and medical staff can positively affect Black maternal and infant health by shifting our causal paradigm. By eliminating the use of Black “race” as a risk factor and naming anti-Black racism as the root cause of Black patients' vulnerability, we can practice anti-racist maternity care and take a critical step toward achieving birth equity.

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confidence: 99%

Why Causation Matters

Mayne,

Buckley,

Ghidei

2023

Obstetrics &Amp; Gynecology

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“…Disparate treatment of Women of Color ranges from racebased clinical algorithms that, until very recently, dissuaded physicians from pursuing a VBAC in Black and Hispanic women [54][55][56][57][58] to practitioners seeing pain differently in Women of Color. 11,59,60 One study found pain management and treatment were significantly less for Black and Hispanic women, even though reports of pain were no less compared with their White counterparts.…”

Section: From Vaginal Birth After Cesarean (Vbac) To Pain Managementmentioning

confidence: 99%

The impact of devaluing Women of Color: stress, reproduction, and justice

Mayne,

Ghidei

2024

Birth

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This commentary is in response to the Call for Papers put forth by the Critical Midwifery Studies Collective (June 2022). We argue that due to a long and ongoing history of gendered racism, Women of Color are devalued in U.S. society. Devaluing Women of Color leads maternal healthcare practitioners to miss and even dismiss distress in Women of Color. The result is systematic underdiagnosis, undertreatment, and the delivery of poorer care to Women of Color, which negatively affects reproductive outcomes generally and birth outcomes specifically. These compounding effects exacerbate distress in Women of Color leading to greater distress. Stress physiology is ancient and intricately interwoven with healthy pregnancy physiology, and this relationship is a highly conserved reproductive strategy. Thus, where there is disproportionate or excess stress (distress), unsurprisingly, there are disproportionate and excess rates of poorer reproductive outcomes. Stress physiology and reproductive physiology collide with social injustices (i.e., racism, discrimination, and anti‐Blackness), resulting in pernicious racialized maternal health disparities. Accordingly, the interplay between stress and reproduction is a key social justice issue and an important site for theoretical inquiry and birth equity efforts. Fortunately, both stress physiology and pregnancy physiology are highly plastic—responsive to the benefits of increased social support and respectful maternity care. Justice means valuing Women of Color and valuing their right to have a healthy, respected, and safe life.

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“…It is important to highlight that even for the consideration of VBAC, the criteria for study eligibility may be related to the racial and structural inequities embedded in the VBAC calculator (Rubashkin, 2022;Vyas et al, 2019), which has, historically, disproportionately limited access to VBAC for non-White birthing people, despite research (e.g., Buckley et al, 2022) demonstrating that utilization of race and ethnicity in the VBAC calculator does not contribute to accurate predictions of VBAC outcome. Future research should continue to emphasize the context of racism to increase awareness of racial and ethnic inequities in VBAC access.…”

Section: Limitations and Future Directionsmentioning

confidence: 99%

“Not that it makes you less of a mother, but…”: Navigating discourses of responsible motherhood in the context of VBAC

Hooberman

Howell

Keegan

et al. 2023

Feminism & Psychology

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In the United States, pregnant people considering a vaginal birth after cesarean delivery (VBAC) face this decision in a highly contested environment where VBAC is simultaneously encouraged—situated within discourses promoting vaginal birth—and discouraged through discourses emphasizing reproductive risk. Woven through these competing discourses is a shared emphasis on maternal responsibility, reflective of a socially constructed belief that birth method is bound implicitly to one's “goodness” as a mother. This paper employs a discursive analytic lens to examine the experiences of 16 pregnant people in New York City seeking VBACs for their upcoming births. We examine how sociocultural discourses of “responsible” mothering shape participants’ experiences of considering VBAC and examine participants’ anxieties over VBAC and its attainability in light of their past birth experiences. Our analysis demonstrates that participants reproduce discourses privileging vaginal birth, and simultaneously challenge these discourses by invoking an “embodied knowledge” that enables them to assert themselves as responsible mothers in the context of past cesarean deliveries and uncertainty surrounding their upcoming births. Implications are discussed in the context of existing literature on birth and discourses of maternal responsibility.

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Racial and Ethnic Disparities Among Women Undergoing a Trial of Labor After Cesarean Delivery: Performance of the VBAC Calculator with and without Patients’ Race/Ethnicity

Cited by 9 publications

References 8 publications

Why Causation Matters

Why Causation Matters

The impact of devaluing Women of Color: stress, reproduction, and justice

“Not that it makes you less of a mother, but…”: Navigating discourses of responsible motherhood in the context of VBAC

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