Patient-Led Approaches to a Vaginal Birth After Cesarean Delivery Calculator
- PMID: 37734092
- PMCID: PMC10510781
- DOI: 10.1097/AOG.0000000000005323
Patient-Led Approaches to a Vaginal Birth After Cesarean Delivery Calculator
Abstract
Objective: To describe patient approaches to navigating their probability of a vaginal birth after cesarean (VBAC) within the context of prediction scores generated from the original Maternal-Fetal Medicine Units' VBAC calculator, which incorporated race and ethnicity as one of six risk factors.
Methods: We invited a diverse group of participants with a history of prior cesarean delivery to participate in interviews and have their prenatal visits recorded. Using an open-ended iterative interview guide, we queried and observed these individuals' mode-of-birth decisions in the context of their VBAC calculator scores. We used a critical and feminist approach to analyze thematic data gleaned from interview and visit transcripts.
Results: Among the 31 participants who enrolled, their self-identified racial and ethnic categories included: Asian or South Asian (2); Black (4); Hispanic (12); Indigenous (1); White (8); and mixed-Black, -Hispanic, or -Asian background (4). Predicted VBAC success probabilities ranged from 12% to 95%. Participants completed 64 interviews, and 14 prenatal visits were recorded. We identified four themes that demonstrated a range of patient-led approaches to interpreting the probability generated by the VBAC calculator: 1) rejecting the role of race and ethnicity; 2) reframing failure, finding success; 3) factoring the physical experience of labor; and 4) modifying the probability for VBAC.
Conclusion: Our findings demonstrate that a numeric probability for VBAC may not be highly valued or important to all patients, especially those who have strong intentions for VBAC. Black and Hispanic participants challenged the VBAC calculator's incorporation of race and ethnicity as a risk factor and resisted the implication it produced, especially that their bodies were less capable of achieving a vaginal birth. Our findings suggest that patient-led approaches to assessing and interpreting VBAC probability may be an untapped resource for achieving a more person-centered, equitable approach to counseling.
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
Conflict of interest statement
Financial Disclosure Nicholas Rubashkin disclosed receiving payment from Simon Law PC, and Marsh, Rickard, & Bryan PC, for expert witness testimony. He sits on the board of an international non-profit named Human Rights in Childbirth. This is a volunteer and unpaid position. Saraswathi Vedam's research lab is engaged in participatory action research around experiences of pregnancy and childbirth care, and health equity measurement. They have co-developed several patient-oriented measures on autonomy, respect, and mistreatment and an institutional quality improvement metric assessing alignment with evidence-based practice to support physiologic birth. Carolyn Sufrin's institution received payment from the National Institute on Drug Abuse. She received payment from the National Commission on Correctional Health Care Resources, Inc., and honoraria from various academic institutions for providing grand rounds. Dr. Sufrin serves in a volunteer capacity on the NCCHC Board of Directors as the liaison for ACOG. She receives travel reimbursement from ACOG for travel to board meetings. The other authors did not report any potential conflicts of interest.
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