Associate clinical professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of California, San Francisco.
AMA J Ethics. 2022 Mar 1;24(3):E233-238. doi: 10.1001/amajethics.2022.233.
In 2010, the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network developed a decision aid, the Vaginal Birth After Cesarean (VBAC) calculator, to help clinicians discern how one variable (race) might influence patients' success in delivering a baby vaginally following a prior birth by cesarean. The higher rate of cesarean deliveries among Black and Hispanic women in the United States has long demonstrated racial inequities in obstetrical care, however. Although the MFMU's new VBAC calculator no longer includes race or ethnicity, in response to calls for abolition of race-based medicine, this article argues that VBAC calculator use has never been race neutral. In fact, VBAC calculator use in the United States is laced with racism, compromises patients' autonomy, and undermines informed consent.
2010 年,美国国家儿童健康与人类发展研究所母婴医学单位(MFMU)网络开发了一种决策辅助工具,即阴道分娩后剖宫产(VBAC)计算器,以帮助临床医生了解一个变量(种族)如何影响患者在前次剖宫产分娩后的阴道分娩成功率。然而,在美国,黑人和西班牙裔女性的剖宫产率一直较高,这表明产科护理存在种族不平等。尽管 MFMU 的新 VBAC 计算器不再包含种族或族裔,但为了响应废除基于种族的医学的呼吁,本文认为 VBAC 计算器的使用从未是种族中立的。事实上,VBAC 计算器在美国的使用充满了种族主义,损害了患者的自主权,并破坏了知情同意。