Department of Obstetrics, Gynecology, & Reproductive Sciences, the Institute for Global Health Sciences, the Department of Family Health Care Nursing, School of Nursing, and the Department of Anthropology, History and Social Medicine, University of California, San Francisco, San Francisco, California; the Birth Place Lab and the School of Population & Public Health, University of British Columbia, Vancouver, British Columbia, Canada; and the Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Obstet Gynecol. 2023 Oct 1;142(4):893-900. doi: 10.1097/AOG.0000000000005323. Epub 2023 Sep 7.
To describe patient approaches to navigating their probability of a vaginal birth after cesarean (VBAC) within the context of prediction scores generated from the original Maternal-Fetal Medicine Units' VBAC calculator, which incorporated race and ethnicity as one of six risk factors.
We invited a diverse group of participants with a history of prior cesarean delivery to participate in interviews and have their prenatal visits recorded. Using an open-ended iterative interview guide, we queried and observed these individuals' mode-of-birth decisions in the context of their VBAC calculator scores. We used a critical and feminist approach to analyze thematic data gleaned from interview and visit transcripts.
Among the 31 participants who enrolled, their self-identified racial and ethnic categories included: Asian or South Asian (2); Black (4); Hispanic (12); Indigenous (1); White (8); and mixed-Black, -Hispanic, or -Asian background (4). Predicted VBAC success probabilities ranged from 12% to 95%. Participants completed 64 interviews, and 14 prenatal visits were recorded. We identified four themes that demonstrated a range of patient-led approaches to interpreting the probability generated by the VBAC calculator: 1) rejecting the role of race and ethnicity; 2) reframing failure, finding success; 3) factoring the physical experience of labor; and 4) modifying the probability for VBAC.
Our findings demonstrate that a numeric probability for VBAC may not be highly valued or important to all patients, especially those who have strong intentions for VBAC. Black and Hispanic participants challenged the VBAC calculator's incorporation of race and ethnicity as a risk factor and resisted the implication it produced, especially that their bodies were less capable of achieving a vaginal birth. Our findings suggest that patient-led approaches to assessing and interpreting VBAC probability may be an untapped resource for achieving a more person-centered, equitable approach to counseling.
在最初的母胎医学单位 VBAC 计算器所生成的预测评分的背景下，描述患者在选择阴道分娩（VBAC）时的方法，该评分将种族和民族作为六个风险因素之一。
我们邀请了一组具有先前剖宫产史的不同参与者参与访谈，并记录他们的产前就诊。使用开放式迭代访谈指南，我们根据他们的 VBAC 计算器评分，询问并观察这些个体在分娩方式选择方面的情况。我们使用批判和女性主义方法分析从访谈和就诊记录中提取的主题数据。
在 31 名入组的参与者中，他们自我认定的种族和民族类别包括：亚裔或南亚裔（2 人）；黑人（4 人）；西班牙裔（12 人）；原住民（1 人）；白人（8 人）；以及混合黑、混合西班牙裔或混合亚裔背景（4 人）。预测 VBAC 成功率从 12%到 95%不等。参与者完成了 64 次访谈，记录了 14 次产前就诊。我们确定了四个主题，这些主题展示了患者对 VBAC 计算器生成的概率进行解释的一系列方法：1）拒绝种族和民族的作用；2）重新定义失败，寻找成功；3）考虑分娩的身体体验；4）修改 VBAC 的概率。
我们的研究结果表明，对于所有患者来说，VBAC 的数字概率可能不是非常有价值或重要的，尤其是那些强烈希望 VBAC 的患者。黑人和西班牙裔参与者对 VBAC 计算器将种族和民族作为风险因素的做法提出了质疑，并抵制它所产生的影响，尤其是暗示他们的身体不太可能实现阴道分娩。我们的研究结果表明，患者主导的方法来评估和解释 VBAC 概率可能是一种未被充分利用的资源，可以实现更以患者为中心、更公平的咨询方法。
