Patient-Led Approaches to a Vaginal Birth After Cesarean Delivery Calculator

Area of Science:

• Reproductive Health
• Maternal-Fetal Medicine
• Health Disparities

Background:

• The Maternal-Fetal Medicine Units' (MFMU) VBAC calculator predicts vaginal birth after cesarean (VBAC) success.
• This calculator incorporates race and ethnicity as risk factors, raising concerns about equity.
• Patient perspectives on navigating these predictions are crucial for informed decision-making.

Purpose of the Study:

• To describe how patients interpret VBAC probability scores.
• To explore patient approaches to using VBAC calculator predictions, particularly concerning race and ethnicity.
• To identify patient-led strategies for understanding birth after cesarean outcomes.

Main Methods:

• Qualitative study involving interviews and recorded prenatal visits with diverse patients with prior cesarean delivery.
• Used a critical and feminist approach to analyze thematic data.
• Examined patient decision-making in the context of MFMU VBAC calculator scores.

Main Results:

• Thirty-one participants represented diverse racial and ethnic backgrounds.
• Predicted VBAC success probabilities varied widely (12%-95%).
• Identified four patient-led interpretation themes: rejecting race/ethnicity, reframing failure, considering labor experience, and modifying probability.

Conclusions:

• Numeric VBAC probability may not be universally valued, especially for those with strong VBAC intentions.
• Black and Hispanic participants challenged the calculator's racial/ethnic risk factors, resisting implications of reduced capability.
• Patient-led interpretation of VBAC probability offers a resource for person-centered, equitable counseling.