You might be surprised to know that we have encountered racism directed towards our laboring clients. In addition to that, as we keep digging into VBAC and the issues surrounding it, the more we learn about the unique challenges that face Women of Color, especially black women.

1. The VBAC Calculator is Biased Against Race

The VBAC Calculator is a collection of data from 7,600 women who had a TOLAC (ACOG, 2017). It calculates any woman’s chance of success against that data. There are several data points used for the calculation including maternal age, BMI, the reason for past C-section, if there has ever been a vaginal delivery before and/or after the C-section and race used to be a factor. Yep, Race. Being African-American or Hispanic decreased your chances a LOT. It wasn't until the last couple of years that this was removed from the calculator, so for many years, people were given a lower percentage based off of this check box. ANNOYING RIGHT?

The unfortunate thing is that a lot of providers will not support VBAC if someone’s predicted success rate is less than 70%. That pretty much rules out most Women of Color for VBAC (really, you NEED to play around with the VBAC calculator). The good thing is, ACOG states that a predicted success rate of less than 60% is not a contraindication for TOLAC.

Julie’s very first VBAC client, who just happened to be Hispanic, had a predicted success rate of just 4%, yes FOUR. She pushed her baby out in 20 minutes. Take that, VBAC calculator!

2. Women of Color are Significantly More Likely to Have a Cesarean Birth and Even Die During Childbirth

Racism during childbirth is not limited to just VBAC. Women of Color are twice as likely to have Cesarean births and are 3-4 times more likely to die during childbirth (Perry, 2016). These numbers hold true despite education level, income level, or socioeconomic status. This. Is. Not. Okay.

Julie once had a client whose first language was Spanish. She was born in Mexico, as was her husband. They both understood and spoke English very well. When they got to the hospital, the nurse, a white woman, mid to late 50s, would only speak to her in a slow tone asking questions followed by, “Do you know what that means?” She acted like she was a Kindergartner leaning about birth procedures for the first time. However, that was even much better than when she started using broken Spanish to try to talk to the birthing couple so that Julie couldn’t understand what she was telling them.

Sadly, this was one of her most educated and intuitive clients. She was judged immediately by the color of her skin and her accent, and, as the birth went on and some unexpected things happened, all the L&D and even postpartum staff were very vocal on blaming this mother for “endangering her baby”. This all took a heavy toll on this mother’s heart--all due to her race.

3. Women of Color Are Significantly Less Likely to Have a Successful VBAC

In an analysis of over 100,000 births, this study shows that white, non-Hispanic women are almost 10% more likely to have a successful VBAC than black, non-Hispanic women (Holland, et al., 2006). Again, these outcomes are despite education level, income level, or socioeconomic status. Sadly, these numbers are similar among various studies and time frames for the last 20 years. Women of Color in the Southern parts of the United States have the highest chances of Cesarean birth and lowest chances of VBAC while women in the Northeast see less of a racial disparity.