Join Jen Kamel as she sits down with physician scientist and VBAC calculator researcher Dr. Nicholas Rubashkin, MD, PhD, an Associate Professor at UC San Francisco, to discuss the historical and cultural implications of the VBAC calculator, a tool used to predict vaginal birth after cesarean (VBAC) odds.
The conversation uncovers how the calculator has propagated racist assumptions that Black and Hispanic bodies are less capable of vaginal birth, the consequences of those assumptions on maternal care, and the problematic "60% threshold."
They explore how to shift the conversation from risk-based to goal-oriented, how problems remain even after race and ethnicity were removed from the tool, recent research out of Sweden, and the fundamental ethical issues at the root of the calculator.
The episode also addresses the concept of "controlling risk in advance," ethical implications of using surgery as a default solution, why some midwives don't use the calculator, and provides insights into future research and practices aimed at increasing equitable access to VBAC.
02:11 His Training and Background
09:25 How He Decided to Study the VBAC Calculator
11:25 Is VBAC a Political Issue?
13:38 New Limitations on Research Grants
16:48 The Many VBAC Calculators
20:37 How to Define Uterine Rupture
21:45 Race as a Risk Factor
23:28 The Power of Lived Experience in Research
25:55 It's Not Race, It's Racism
27:56 How Race & Racism Were Built Into the Calculator
29:28 Race & Ethnicity Removed from the VBAC Calculator
32:13 A New Form of Scientific Racism
33:03 Removing Race, Problems Remain
35:34 Response to VBAC Calculator Critique
38:34 Reader Q: Validate Prior FTP Cesarean
42:27 Swedish Study: 10cm FTP Diagnosis & Future VBAC Odds
43:36 Script for Using the Calculator
44:44 Reader Q: Psychosocial Elements of FTP
47:07 Science Beyond VBAC Calculator Comes From Oncology!
47:59 Calculator Contributes to Informed Consent?
51:04 Where to Start: VBAC Calculator & Informed Consent
54:01 Controlling Risk in Advance
01:01:02 The Fundamental Ethical Issue
01:03:16 The 60% Threshold
01:08:02 The "Necessity" of The 40/41-Week Scheduled Cesarean
01:10:28 Goal Oriented Conversations
Have a comment or question for the podcast? Want to suggest a guest we should interview or a topic we should discuss? Go to https://vbacfacts.com/podcast to give us your feedback!
- Contribute to the VBAC Facts® BIPOC Scholarship Fund | VBAC Facts®
- Vaginal Birth After Cesarean Calculator (MFMU)
- Episode 6 Decoding the VBAC Calculator: Science, Bias, and Decision Making | The VBAC Facts® Podcast - Apple Podcasts
- Study finds that VBAC calculators underpredict VBAC odds. They are also racially biased. | VBAC Facts®
- Sign up for your copy of the VBAC Planning Checklist! | VBAC Facts®
- Consulting for Parents, Professionals, Legal & Policy Teams │ VBAC Facts®
- Professional Speaking with Jen Kamel │ VBAC Facts®
- Sign up for your copy of the Top Three VBAC Myths! | VBAC Facts®
- Sign up for your copy of the Uterine Rupture Report! | VBAC Facts®
- The Truth About Vaginal Birth After Cesarean™ for Families | VBAC Facts® Educational Course for Parents
- VBAC Facts® Professional Membership | VBAC Facts® Continuing Education
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