E14 An OB Scientist's Caution on the VBAC Calculator and Informed Consent with Dr. Nicholas Rubashkin MD PhD

The VBAC Facts® Podcast with Jen Kamel

Ever use the VBAC calculator? Then you will want to listen to physician scientist and VBAC calculator researcher Dr. Nicholas Rubashkin, MD, PhD, an Associate Professor at UC San Francisco, as he reviews the historical and cultural implications of the VBAC calculator, a tool used to predict vaginal birth after cesarean (VBAC) odds.

The conversation uncovers how the calculator has propagated racist assumptions that Black and Hispanic bodies are less capable of vaginal birth, the consequences of those assumptions on maternal care, and the problematic "60% threshold."

They explore how to shift the conversation from risk-based to goal-oriented, how problems remain even after race and ethnicity were removed from the tool, recent research out of Sweden, and the fundamental ethical issues at the root of the calculator.

The episode also addresses the concept of "controlling risk in advance," ethical implications of using surgery as a default solution, why some midwives don't use the calculator, and provides insights into future research and practices aimed at increasing equitable access to VBAC.

02:11 His Training and Background

09:25 How He Decided to Study the VBAC Calculator

11:25 Is VBAC a Political Issue?

13:38 New Limitations on Research Grants

16:48 The Many VBAC Calculators

20:37 How to Define Uterine Rupture

21:45 Race as a Risk Factor

23:28 The Power of Lived Experience in Research

25:55 It's Not Race, It's Racism

27:56 How Race & Racism Were Built Into the Calculator

29:28 Race & Ethnicity Removed from the VBAC Calculator

32:13 A New Form of Scientific Racism

33:03 Removing Race, Problems Remain

35:34 Response to VBAC Calculator Critique

38:34 Reader Q: Validate Prior FTP Cesarean

42:27 Swedish Study: 10cm FTP Diagnosis & Future VBAC Odds

43:36 Script for Using the Calculator

44:44 Reader Q: Psychosocial Elements of FTP

47:07 Science Beyond VBAC Calculator Comes From Oncology!

47:59 Calculator Contributes to Informed Consent?

51:04 Where to Start: VBAC Calculator & Informed Consent

54:01 Controlling Risk in Advance

01:01:02 The Fundamental Ethical Issue

01:03:16 The 60% Threshold

01:08:02 The "Necessity" of The 40/41-Week Scheduled Cesarean

01:10:28 Goal Oriented Conversations

Have a comment or question for the podcast? Want to suggest a guest we should interview or a topic we should discuss? Go to https://vbacfacts.com/podcast to give us your feedback!

• Downloadable Checklist: The 5 Simple Steps to Planning a VBAC | VBAC Facts®
• Downloadable Report: Top 5 Uterine Rupture Myths Debunked Once and For All | VBAC Facts®
• Contribute to the VBAC Facts® BIPOC Scholarship Fund | VBAC Facts®
• Vaginal Birth After Cesarean Calculator (MFMU)
• Episode 6 Decoding the VBAC Calculator: Science, Bias, and Decision Making | The VBAC Facts® Podcast - Apple Podcasts
• Study finds that VBAC calculators underpredict VBAC odds. They are also racially biased. | VBAC Facts®
• Consulting for Parents, Professionals, Legal & Policy Teams │ VBAC Facts®
• Professional Speaking with Jen Kamel │ VBAC Facts®
• Sign up for your copy of the Top Three VBAC Myths! | VBAC Facts®
• The Truth About Vaginal Birth After Cesarean™ for Families | VBAC Facts® Educational Course for Parents
• VBAC Facts® Professional Membership | VBAC Facts® Continuing Education

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