E6: Decoding the VBAC Calculator: Science, Bias, and Decision Making

Описание: Think the VBAC calculator is rooted in solid medical evidence? This episode with VBAC Facts® Founder Jen Kamel dives into the accuracy and impact of VBAC calculators. Jen discusses a variety of factors influencing predicted VBAC odds as well as actual VBAC rates, including race, BMI, reason for prior cesarean, bias, provider preference, and VBAC bans. Key research, such as Harris 2019, Nguyen 2020, and most recently Ledbetter 2024, reveal that VBAC calculators often underpredict VBAC odds. Hear lived experiences from readers and the challenges they face with the application of these calculators. Learn more about the strengths and limitations of VBAC calculators and their impact on informed decision-making in birthing choices.

00:22 Introduction to VBAC Calculators
02:30 Study Questions VBAC Accuracy: Harris 2019
05:47 The Role of a Prior Failure to Progress (FTP) Cesarean
07:31 ACOG's Labor Arrest/ FTP Definitions
09:48 On Calibrating VBAC Calculators Before Use
11:19 Impact of Race & Racism on VBAC Odds
14:59 Readers Share Their VBAC Calculator Experiences
19:27 BMI, Bias, and VBAC Calculators
21:20 Limitations and Misuse of VBAC Calculators
26:13 VBAC Calculator Latinx Accuracy: Nguyen 2020
27:36 VBAC Calculator Hispanic BMI Accuracy: Ledbetter 2024
33:50 BMI & the VBAC Calculator: A Reader's Story
39:17 Relevant Factors the VBAC Calculator Doesn't Consider
40:53 ACOG: Recruit Me for the VBAC Practice Bulletin Committee
42:27 Questions to Ask Yourself Before You Use the VBAC Calculator
43:06 Final Thoughts and Resources

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!

Read the companion article, see the first three VBAC calculators, and download the handout for this episode. https://vbacfacts.com/calculator
Birth Monopoly's How to File A Complaint for Mistreatment in Maternity Care. https://birthmonopoly.com/how-to-file...
The Maternal-Fetal Medicine Network VBAC calculator. https://mfmunetwork.bsc.gwu.edu/web/m...
"In an effort to reduce the number of primary cesareans, ACOG released new labor arrest definitions in 2014." American College of Obstetricians & Gynecologists and the Society for Maternal-Fetal Medicine. (2014). Safe prevention of the primary cesarean delivery. Obstetric Care Consensus No. 1. Obstetrics & Gynecology, 123, 693-711. https://www.ajog.org/article/S0002-93...
Collins, J. W., David, R. J., Handler, A., et al. (2004). Very low birthweight in African American infants: The role of maternal exposure to interpersonal racial discrimination. American Journal of Public Health, 94(12), 2132-2138. https://www.ncbi.nlm.nih.gov/pmc/arti...
Harris, B. S., Heine, P. H., Park, J., Faurot, K., Hopkins, M., Rivara, A., . . . Jelovsek, E. (2019). Are prediction models for vaginal birth after cesarean accurate? American Journal of Obstetrics & Gynecology, 220, 492.e1-7. http://dx.doi.org/10.1016/j.ajog.2019...
Ledbetter, A., Wandtke Herrmann, T., Lupa, K., & Graupe, M. (2024). Observed Versus Predicted Vaginal Birth After Cesarean for Patients of a Community Health Center. Journal of Midwifery & Women's Health. https://onlinelibrary.wiley.com/doi/1...
Metz, T. D., Stoddard, G. J., Henry, E., et al. (2013). How do good candidates for trial of labor after cesarean (TOLAC) who undergo elective repeat cesarean differ from those who choose TOLAC? American Journal of Obstetrics & Gynecology, 208(6), 458.e1-6. https://www.ncbi.nlm.nih.gov/pubmed/2...
Nguyen, M. T., Hayes-Bautista, T. M., Hsu, P., Bragg, C., Chopin, I., & Shaw, K. J. (2020). Applying a Prediction Model for Vaginal Birth after Cesarean to a Latina Inner-City Population. American Journal of Perinatology Reports, 10(02), e148-e154. https://pubmed.ncbi.nlm.nih.gov/32309...
"One study reported that half of those who had a cesarean for FTP after labor induction were not even 6 centimeters." Zhang, J., Troendle, J., Reddy, U.,et al. (2010). Contemporary cesarean delivery practice in the United States. The American Journal of Obstetrics & Gynecology, 203(4), 326.e1-326.e10. https://www.ncbi.nlm.nih.gov/pubmed/2...
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