ArticleJournal of racial and ethnic health disparities2026
Automating Racism: Is Use of the Vaginal Birth After Cesarean Calculator Associated with Inequity in Perinatal Service Delivery?
Article in Journal of racial and ethnic health disparities, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
2 citing papers in PubMed.
- Association Between Racial Segregation of Labor and Delivery Services and Utilization of Trial of Labor and Vaginal Birth After Cesarean.Obstetrics and gynecology · 2026Observational
- Racial and Ethnic Disparities in Cesarean Birth Trends in the United States.JAMA network open · 2025Observational
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
Abstract
objectiveThe clinical application of race-adjusted algorithms may perpetuate health inequities. We assessed the impact of the vaginal birth after cesarean (VBAC) calculator, which was revised in 2021 to address concerns about equity. The original algorithm factored race and ethnicity and gave lower VBAC probabilities to Black and Hispanic patients.
methodsFrom 2019 to 2020, we conducted a multi-site, ethnographic study consisting of interviews and audio recordings of 14 prenatal visits. We used grounded theory to describe the social processes of racialization.
findingsAcross 4 sites, 12 obstetricians, 5 midwives, and 31 pregnant/postpartum patients participated. Seventy-four percent (N = 23) of the pregnant/postpartum individuals identified as racially minoritized, and the remaining 24% (N = 8) identified as White. We identified four processes that facilitated the "automation" of racism: adhering to strict cutoffs; the routine adoption of calculators; obfuscating the calculator; and the reflexive categorization of race and ethnicity. When clinicians adhered to strict cutoffs, they steered low-scoring Black and Hispanic patients toward repeat cesareans. If clinicians obfuscated the calculator, Black and Hispanic patients had to work to decode the role of race and ethnicity in their probabilities in order to pursue a VBAC. By reflexively categorizing race and ethnicity, the use of the calculator forced patients to choose a singular identity, even if it obscured the truth about their multi-faceted race or ethnicity.
conclusionThe VBAC calculator's inclusion of race and ethnicity helped to automate racism by coding race into institutional practices and care interactions. This resulted in some clinicians discouraging or prohibiting Black and Hispanic patients from attempting a VBAC. SIGNIFICANCE: To date, no empiric study has examined whether the VBAC calculator produced inequities in access to VBAC services and reproduced racism in care. The VBAC calculator resulted in fewer VBAC attempts among racially minoritized patients, denying them the opportunity to undergo labor and a vaginal birthing experience.
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