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VBAC Calculator Bold text

Since 2007, obstetricians have created a patient’s birth plan after a previous C-section using a calculator designed to determine the likelihood of having a successful vaginal birth, or VBAC. The tool takes into account demographics like a patient’s age, height, weight, and their obstetrics history. The VBAC calculator also has two race based correction factors, for African American and Hispanic patients, that “subtract” from the likelihood of successful vaginal birth. Although race does not have an influence on biological composition, it has been used to assess a woman’s probability of successful vaginal birth after receiving a C section. This subtraction is only based on race, and has put Hispanic and Black women in riskier situations than their white counterparts. The VBAC calculator was endorsed by the National Institute of Child Health and Human Development, and was created in attempts to assist providers in their risk assessment for a patient's vaginal birth plan. This calculator accounts for various risk factors, including age, BMI, and previous health complications, which could have impacts on a woman's birth outcomes. However, the inclusion of race/ethnicity as a factor can create disparities in pregnancy outcomes. According to the VBAC calculator, a 30-year-old woman, with a prior cesarean delivery has a predicted chance of successful vaginal birth of 66.1% if White, but only 49.9% if Black. In most cases, vaginal birth can have positive implications, like avoidance of surgery and surgical complications, lower risk of postpartum hemorrhage and infection, faster recovery time, and lower risk of complications during subsequent pregnancies. Subjecting people of color as ineligible to receiving the safer pregnancy outcome can be highly detrimental to the safety of some pregnant patients. In 2021, researchers decided to update the calculator to remove any question of race. The updated tool performs with the same level of accuracy as the previous version, and stays true to its original purpose of giving all pregnant patients the best level of care. In fact, the calculator includes a new, more objective clinical variable: whether or not a patient has been treated for chronic hypertension, which can impact the amount of blood flow to the placenta. Factoring hypertension, along with all other applicable demographics, can help create the safest and most effective birth plan for pregnant patients.