Removal of the Race-Based Correction in the Vaginal Birth After Cesarean Calculator

In 2007, the Maternal-Fetal Medicine Units Network published a clinical calculator with a race-based correction factor that systematically lowered the predictive probability of a Black or Hispanic woman having a successful vaginal birth after cesarean (VBAC). The ensuing pushback that race is a social construct and not a biological factor led to the removal of race and ethnicity in the updated Maternal-Fetal Medicine Units Network VBAC calculator in 2021. In this column, I provide a brief overview of the inclusion of race in clinical algorithms and the development of VBAC calculators, evaluations of the calculators on VBACs by race and ethnicity, and the implications for research, practice, and policy. I conclude with information from professional organizations and the need for updating clinical guidelines to recommend health care systems and clinicians to adopt the revised VBAC calculator.