ArticleReproductive sciences (Thousand Oaks, Calif.)2022
Racial and Ethnic Disparities Among Women Undergoing a Trial of Labor After Cesarean Delivery: Performance of the VBAC Calculator with and without Patients' Race/Ethnicity.
Article in Reproductive sciences (Thousand Oaks, Calif.), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it, 21 citations in OpenAlex.
- Effects of Race, Ethnicity and Socioeconomic Deprivation on Postpartum Haemorrhage in High-Income Countries: A Systematic Review and Meta-Analysis.BJOG : an international journal of obstetrics and gynaecology · 2025Pooled it
- Strategies for mitigating artificial intelligence bias in healthcare: a systematic review.JAMIA open · 2026Review
- Fairness in Low Birthweight Predictive Models: Implications of Excluding Race/Ethnicity.Journal of racial and ethnic health disparities · 2026Article
- Automating Racism: Is Use of the Vaginal Birth After Cesarean Calculator Associated with Inequity in Perinatal Service Delivery?Journal of racial and ethnic health disparities · 2026Article
- Racial Bias in Clinical and Population Health Algorithms: A Critical Review of Current Debates.Annual review of public health · 2025Review
- Clinical Algorithms and the Legacy of Race-Based Correction: Historical Errors, Contemporary Revisions and Equity-Oriented Methodologies for Epidemiologists.Clinical epidemiology · 2025Review
- Development of a prediction model of postpartum hospital use using an equity-focused approach.American journal of obstetrics and gynecology · 2024Article
- Reassessing the Use of Race in Clinical Algorithms: An Interactive, Case-Based Session for Medical Students Using eGFR.MedEdPORTAL : the journal of teaching and learning resources · 2024Article
- Predicting primary cesarean delivery in pregnancies complicated by gestational diabetes mellitus.American journal of obstetrics and gynecology · 2023Article
- Mitigating Racial And Ethnic Bias And Advancing Health Equity In Clinical Algorithms: A Scoping Review.Health affairs (Project Hope) · 2023Article
- Application of Predictive Analytics in Pregnancy, Birth, and Postpartum Nursing Care.MCN. The American journal of maternal child nursingArticle
- Article
Corrections and comments
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Authors and funding
15 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The Maternal Fetal Medicine Units Network (MFMU) vaginal birth after cesarean (VBAC) calculator is a clinical tool designed to predict trial of labor after cesarean delivery (TOLAC) success. The calculator has come under scrutiny for its inclusion of race and ethnicity, which systematically predicts a lower likelihood of success for patients who identify as African American or Hispanic. We hypothesized that the calculator would predict VBAC more accurately without the use of race or ethnicity. A retrospective chart review including all patients undergoing TOLAC from 2016 to 2019 was conducted. A multivariate logistic regression was used to compare one model that utilizes the original variables in predicting VBAC (model 1) and another that uses the same variables except for race and ethnicity (model 2). In model 1, race and ethnicity were the only variables not associated with the probability of successful TOLAC (p = 0.065). The area under the curve (AUC) for models 1 and 2 were 0.77 and 0.78, respectively. There was not a statistically significant difference between the predictive abilities of the two models (p = 0.40). Rates of PPH (p = 0.001), abruption (p = 0.04), intra-amniotic infection (p < 0.0001), and other postpartum complications (p = 0.005) differed significantly by race and ethnicity. The use of race and ethnicity did not contribute to the accuracy of VBAC prediction. The use of race and ethnicity in this predictive model should be omitted to prevent inherent bias and discrimination. There were also significant racial and ethnic differences in overall postpartum complication rates.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.