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

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 201905:47 The Role of a Prior Failure to Progress (FTP) Cesarean07:31 ACOG's Labor Arrest/ FTP Definitions09:48 On Calibrating VBAC Calculators Before Use11:19 Impact of Race & Racism on VBAC Odds 14:59 Readers Share Their VBAC Calculator Experiences19:27 BMI, Bias, and VBAC Calculators21:20 Limitations and Misuse of VBAC Calculators 26:13 VBAC Calculator Latinx Accuracy: Nguyen 202027:36 VBAC Calculator Hispanic BMI Accuracy: Ledbetter 202433:50 BMI & the VBAC Calculator: A Reader's Story39:17 Relevant Factors the VBAC Calculator Doesn't Consider40:53 ACOG: Recruit me for the VBAC Practice Bulletin Committee42:27 Questions to Ask Yourself Before You Use the VBAC Calculator43:06 Final Thoughts and ResourcesMentioned on the showRead the companion article, see the first three VBAC calculators, and download the handout for this episode.Birth Monopoly's How to File A Complaint for Mistreatment in Maternity Care. The Maternal-Fetal Medicine Network VBAC calculator. "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. 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. 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. 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...