746 The effects of removing race from the VBAC calculator: implications for counseling

Abstract

To explore the differences between actual vaginal birth after cesarean (VBAC) success rates and the predicted VBAC success scores when calculated both with and without race and ethnicity. A retrospective chart review of an ethnically diverse patient population with 302 women electing trial of labor after cesarean (TOLAC). The MFMU VBAC calculator was used to calculate a predicted VBAC score with and without race and ethnicity. Based on prior studies, a predicted success score of 60% or greater was defined as a favorable VBAC score. Predicted and actual rates of VBAC were then compared. Statistical analysis performed in SAS 9.4. There were no significant differences in VBAC rates when comparing non-Hispanic Black women, aOR 0.5 (95% CI 0.2, 1.28), and Hispanic women, aOR 0.9 (95% CI 0.34, 2.41), to non-Hispanic White women. However, when race and ethnicity were included in the VBAC calculator, non-Hispanic Black and Hispanic women were significantly less likely to have favorable VBAC scores compared to White women, aOR 0.26 (CI 0.1, 0.66) and aOR 0.24 (CI 0.09, 0.64), respectively. When race and ethnicity were excluded from the calculator, there was no longer a significant difference in the predicted VBAC success across racial groups, non-Hispanic Black aOR 1.29 (95% CI 0.49, 3.44); Hispanic aOR 1.71 (95% CI 0.6, 4.92). We found that with race and ethnicity included in the calculator, 33 Hispanic women (44.6%) who had a VBAC, would have been told they had an unfavorable score compared to only 7 women (9.5%) when race was excluded. Similarly, 29 non-Hispanic Black women (43.9%) who had a VBAC, would have been told they had an unfavorable score compared to only 8 women (12.1%) when race and ethnicity were excluded. The inclusion of race and ethnicity in the VBAC calculator underestimated the success rates of women of color and could lead to these women being discouraged from TOLAC when they would have been successful. Our findings support the removal of race from medical decision making.View Large Image Figure ViewerDownload Hi-res image Download (PPT)