Birth In Women Research Articles

Progesterone for Prevention of Miscarriage and Preterm Birth in Women With First-Trimester Bleeding: PREEMPT Trial [A260

Progesterone for Prevention of Miscarriage and Preterm Birth in Women With First-Trimester Bleeding: PREEMPT Trial [A260

Clinicians' Perspectives on Racism and Black Women's Maternal Health.

Objective:The objective of this study was to explore clinician perceptions of how racism affects Black women's pregnancy experiences, perinatal care, and birth outcomes.Materials and Methods:We conducted 25 semi-structured interviews with perinatal care clinicians practicing in the San Francisco Bay Area (January to March 2019) who serve racially diverse women. Participants were primarily recruited through “Dear Perinatal Care Provider” email correspondences sent through department listservs. Culturally concordant, qualitatively trained research assistants conducted all interviews in person. The interviews ranged from 30 to 60 minutes and were audio-recorded and professionally transcribed verbatim. We used the constant comparative method consistent with grounded theory to analyze data.Results:Most participants were obstetrician/gynecologists (n = 11, 44%) or certified nurse midwives (n = 8, 32%), had worked in their current role for 1 to 5 years (n = 10, 40%), and identified as white (n = 16, 64%). Three themes emerged from the interviews: provision of inequitable care (e.g., I had a woman who had a massive complication during her labor course and felt like she wasn't being treated seriously); surveillance of Black women and families (e.g., A urine tox screen on the Black baby even though it was not indicated, and they didn't do it on the white baby when, in fact, it was indicated); and structural care issues (e.g., the history of medical racial experimentation).Conclusion:Clinicians' views about how racism is currently operating and negatively impacting Black women's care experiences, health outcomes, and well-being in medical institutions will be used to develop a racial equity training for perinatal care clinicians in collaboration with Black women and clinicians.

Validation of a Nomogram for Predicting Preterm Birth in Women With Threatened Preterm Labor: A Prospective Cohort Study in Iranian Tertiary Referral Hospitals.

In this prospective cohort study, we aimed to investigate external validity of the Allouche's nomogram to predict preterm birth in symptomatic women in Iran. We employed six variables of cervical length, uterine contractions, rupture of membranes, vaginal bleeding, gestational age, and multiple pregnancy to draw the nomograms. These variables were examined in the first day of women's hospitalization and participants followed up until giving birth. The concordance index of area under the curve (AUC) was used for validation of the nomograms. Of the participants 10% gave birth within 48 hours and 29% before 34 weeks. The nomogram had sufficient accuracy in predicting birth within 48 hours (AUC 0.89 [95% CI 0.82-0.96]) and birth before 34 weeks (AUC 0.89 [95% CI 0.84-0.94]). The optimal risk threshold for nomogram predicting birth within 48 hours was 0.16. Use of these two nomograms, can improve the health of women and their neonates.

Culturally appropriate care to support maternal positions during the second stage of labour: Midwives' perspectives in South Africa.

Background‘Doing what the Romans do in Rome’ was an expression raised by one of the midwives following workplace culture and disregarding women’s birth choices. Midwifery practice in South Africa caters for a culturally diverse ethnic groups of childbearing women. Culturally appropriate care highlights the importance of including women in decision-making concerning their birth preferences including maternal positions during labour. Women’s right to choose their maternal position and cultural preferences during labour has been overlooked, leading to poor maternal healthcare provision and negative birth experiences.AimIn this article, the researchers aimed to describe and explore midwives’ perspectives on culturally appropriate care to support maternal positions during the second stage of labour.SettingMidwives working in the maternity ward in a public hospital in South Africa.MethodsA qualitative descriptive design using individual interviews was used to collect data. The participants were selected using the purposive sampling method. The study population comprised 20 midwives who volunteered to participate in the study. Data were transcribed manually and analysed using thematic analysis.ResultsThe four main themes are as follows: (1) Caring for women from various ethnic groups, (2) midwives disregard women’s beliefs and culture, (3) midwife personal cultural attributes and (4) midwifery unit workplace culture.ConclusionThe authors concluded that culturally appropriate care towards the women’s choices of birth position during the second stage of labour should form an integral part of the midwifery care rendered.

Health Burden and Service Utilization in Texas Medicaid Deliveries from the Prenatal Period to 1 Year Postpartum.

To describe health burden and health service utilization from the prenatal period to 1year postpartum among women with births covered by Texas Medicaid, focusing on the major contributors to maternal mortality after 60days postpartum in Texas. We analyzed diagnoses and health service utilization during the prenatal, early postpartum (5-60days postpartum), and late postpartum (> 60days to 1year postpartum) periods, using administrative medical claims data for women ages 18-44years with a Medicaid-paid delivery in 2017 residing in selected regions in Texas (n = 49,302). Overall, 12.6% and 17.5% of women had diagnoses of cardiovascular/coronary conditions and substance use disorder, respectively. Mental health conditions affected 30% of women, with anxiety (47.1%) and depression (34.3%) accounting for the greatest proportion of diagnosed mental health conditions. The prevalence of these conditions was higher during the late (19.4%) versus early (9.9%) postpartum period. About 47.8% of women had other chronic health conditions, including obesity, diabetes mellitus, and hypertension. Among women with the selected health conditions, utilization of any health services was higher during the prenatal period compared to early and late postpartum periods (e.g., any mental health service utilization: prenatal period (57.4%) versus early postpartum (26.9%) and late postpartum (25.5%) periods). However, among women with the selected health conditions, there was a high utilization of emergency room services during the late postpartum period [e.g., emergency room service utilization among those with mental health conditions: prenatal period (35.6%); postpartum period: early (5.5%) and late (30.1%)]. Increasing access to the full range of recommended services during the prenatal period through 1year postpartum has potential to help improve vulnerable women's birth outcomes.

Associations of maternal birth weight, childhood height, BMI, and change in height and BMI from childhood to pregnancy with risks of preterm delivery

It remains unknown whether maternal early life body size and changes in height and BMI from childhood to pregnancy are associated with risks of having a preterm delivery. We investigated whether a woman's birth weight, childhood height, BMI, and changes in height and BMI from childhood to pregnancy were associated with preterm delivery. We studied 47,947 nulliparous women born from 1940 to 1996 who were included in the Copenhagen School Health Records Register with information on birth weight and childhood heights and weights at ages 7 and/or 13 years. Gestational age was obtained from the Danish Birth Register, as was prepregnancy BMI, for 13,114 women. Deliveries were classified as very (22 to <32 weeks) or moderately (32 to <37 weeks) preterm. Risk ratios (RRs) and 95% CIs were estimated using binomial regression. A woman's birth weight and childhood height were inversely associated with having very and moderately preterm delivery. Childhood BMI had a U-shaped association with having a very preterm delivery; at age 7 years, compared to a BMI z score of 0, the RRs were 1.31 (95% CI, 1.11-1.54) for a z score of -1 and 1.18 (95% CI, 1.01-1.38) for a z score of +1. Short stature in childhood and adulthood was associated with higher risks of very and moderately preterm delivery. Changing from a BMI at the 85th percentile at 7 years (US CDC reference) to a prepregnancy BMI of 22.5kg/m2 was associated with RRs of 1.12 (95% CI, 0.91-1.37) and 0.88 (95% CI, 0.78-0.99) for very and moderately preterm delivery, respectively, compared to a reference woman at the 50th percentile at 7 years (22.5kg/m2 prepregnancy BMI). Maternal birth weight, childhood height, and BMI are associated with very and moderately preterm delivery, although in different patterns. Consistent short stature is associated with very and moderately preterm delivery, whereas normalizing BMI from childhood to pregnancy may reduce risks of having a very preterm delivery.

Development and Evaluation of a Machine Learning Prediction Model for Small-for-Gestational-Age Births in Women Exposed to Radiation before Pregnancy.

Exposure to radiation has been associated with increased risk of delivering small-for-gestational-age (SGA) newborns. There are no tools to predict SGA newborns in pregnant women exposed to radiation before pregnancy. Here, we aimed to develop an array of machine learning (ML) models to predict SGA newborns in women exposed to radiation before pregnancy. Patients’ data was obtained from the National Free Preconception Health Examination Project from 2010 to 2012. The data were randomly divided into a training dataset (n = 364) and a testing dataset (n = 91). Eight various ML models were compared for solving the binary classification of SGA prediction, followed by a post hoc explainability based on the SHAP model to identify and interpret the most important features that contribute to the prediction outcome. A total of 455 newborns were included, with the occurrence of 60 SGA births (13.2%). Overall, the model obtained by extreme gradient boosting (XGBoost) achieved the highest area under the receiver-operating-characteristic curve (AUC) in the testing set (0.844, 95% confidence interval (CI): 0.713–0.974). All models showed satisfied AUCs, except for the logistic regression model (AUC: 0.561, 95% CI: 0.355–0.768). After feature selection by recursive feature elimination (RFE), 15 features were included in the final prediction model using the XGBoost algorithm, with an AUC of 0.821 (95% CI: 0.650–0.993). ML algorithms can generate robust models to predict SGA newborns in pregnant women exposed to radiation before pregnancy, which may thus be used as a prediction tool for SGA newborns in high-risk pregnant women.

Preterm Birth in Women With HIV: The Role of the Placenta.

Maternal HIV infection is associated with an increased risk of preterm birth (PTB). However, the mechanisms underlying this increased risk in women with HIV remain poorly understood. In this regard, it is well-established that labor is an inflammatory process and premature activation of the pro-inflammatory signals (associated with labor) can result in preterm labor which can subsequently lead to PTB. HIV infection is known to cause severe immune dysregulation within its host characterized by altered immune profiles, chronic inflammation and eventually, the progressive failure of the immune system. The human placenta comprises different immune cell subsets, some of which play an important role during pregnancy including participating in the inflammatory processes that accompany labor. It is therefore plausible that HIV/antiretroviral therapy (ART)-associated immune dysregulation within the placental microenvironment may underlie the increased risk of PTB reported in women with HIV. Here, we review evidence from studies that point toward the placental origin of spontaneous PTB and discuss possible ways maternal HIV infection and/or ART could increase this risk. We focus on key cellular players in the maternal decidua including natural killer cells, CD4+ T cells including CD4+ regulatory T cells, CD8+ T cells as well as macrophages.

Relationship of Amniotic Fluid Sludge and Short Cervix With a High Rate of Preterm Birth in Women After Cervical Cerclage.

We aims to determine the relationship of amniotic fluid sludge (AFS) and/or short cervical length (CL, ≤25 mm) with a high rate of preterm birth in women after cervical cerclage. A retrospective cohort study was conducted among singleton pregnancies after cervical cerclage between January 2018 and December 2021. A total of 296 patients who underwent transvaginal ultrasound to evaluate CL and the presence of AFS within 2 weeks after cerclage were included. Pregnancy outcome after cerclage was analyzed in accordance with the presence of AFS and CL ≤25 mm. In patients with cerclage, AFS was an independent risk factor for preterm birth at <28 and <36 weeks but not for preterm birth at <32 weeks, and CL ≤25 mm was an independent risk factor for preterm birth at <28, <32, and <36 weeks. The Kaplan-Meier analysis showed that the association between the presence of AFS and short gestational age at delivery was statistically significant in women with CL ≤25 mm (log rank test, P=.000). The Cox regression analysis showed that these results remained significant after adjusting for confounding factors (P=.000). The negative linear relationships between AFS and CL (R=-0.454, P < .001) also explained the outcome. AFS and short cervix have a direct effect on pregnancies after cerclage. Mid-trimester AFS can become a supplementary ultrasound index for detecting preterm birth after cerclage in pregnant women with a short cervix.

The enduring impact of birth: Women's birth perceptions, postpartum depressive symptoms, and postpartum depression risk.

Postpartum depression (PPD) and related maternal mood disorders affect anywhere from 7% to 19% of postpartum women. Although historically a neglected issue, there has been a strong impetus in the past few decades to implement routine, universal screening and to address PPD as a major public health concern. Still, there has been relatively little analysis of how the quality of the birth experience influences subsequent maternal mental health. We examine the relationship between perceived birth experience and two PPD screeners (Edinburgh Postnatal Depression Scale and Postpartum Depression Screening Scale). Data came from waves I and II of the Listening to Mothers data set. This is the only national survey of US women's childbirth and postpartum experiences. In logistic and linear regression models, we used a 12-item "feeling" index (perceived birth experience) to predict (a) overall PPD screener scores, and (b) likelihood of meeting the clinical cutoff for depression risk. We also controlled for other known socio-demographic and obstetric risk factors. Perceived birth experience strongly and consistently predicted both PPD screener measures, and in both forms-raw scores and clinical cutoffs. By contrast, other known risk factors had inconsistent results across the two screeners. Perceived birth experience should be considered more central in assessing PPD. It may also be more robust than the PPD screeners used in practice, and therefore, could be a more reliable predictor of PPD. Providers should consider how the improved social-psychological quality of women's birth experience can act as a buffer to PPD and other postpartum concerns.

The Arabin Pessary to Prevent Preterm Birth in Women With a Twin Pregnancy and a Short Cervix: The STOPPIT 2 RCT

(Abstracted from Health Technol Assess 2021;25:1–66) In England and Wales, approximately 16 of every 1000 women have a multiple gestation. Multiple pregnancies are associated with higher rates of stillbirth and neonatal and infant mortality, as well as child disability compared with singleton pregnancies.

Muzułmanki w ruchu narodowym Tatarów krymskich od końca XIX wieku. Narodziny aktywizmu kobiet, rola historyczna i pozycja społeczna

Muslim Women in the National Movement of Crimean Tatars since the Late Nineteenth Century. The Birth of Women’s Activism, Their Historic Role and Social Position The socio-political movement of Crimean Tatars since the second half of the nineteenth century, aiming for political and territorial autonomy in Crimea, is traditionally associated with the name of its iconic leader Mustafa Dzhemilev. Meanwhile, a closer look at the nation’s struggle to reach its goals allows us to also see the role of women by no means reduced to the function of mothers and wives of activists. Examples can be drawn from the dawn of the movement to the present day, describing the profiles of prominent female figures whose socio-political activities have influenced the formation of the modern national and religious identity of Crimean Tatars. This publication presents a description and analysis of the role women played in the history of the nation during its independence movement. Using the example of outstanding silhouettes, the author demonstrates that Crimean Tatar women activists often performed key tasks at the most decisive moments of history, which in no small measure influenced the relatively high position of Muslim women in the social hierarchy of the nation.

Progesterone for Prevention of Miscarriage & Preterm Birth in Women with First Trimester Bleeding: PREEMPT-Trial

First trimester bleeding is associated with miscarriage and preterm birth for which progesterone has been suggested to improve outcomes. The objective of our study was to evaluate the effect of progesterone treatment throughout pregnancy on preventing miscarriage and preterm birth in pregnancies with first trimester bleeding.

Facebook as a platform for collecting women's birth stories: Supporting emotional connections between researchers and participants

This paper extends debate on the use of social networking sites in social science research, specifically focusing on their role in creating ‘emotionally connected’ research spaces. Drawing on the authors' experiences of using a closed Facebook group as a platform for collecting women's ‘birth stories’, we explore to potential of Facebook to support the transcendence of traditional researcher/participant relations and empower participants through creating something akin to a ‘Community of Practice’. The project also contributed to a process of inter and intra-personal self-care, which, as a research team, we recognise as an important driver of our research agendas. We acknowledge that the virtual cannot be all-inclusive but conclude that this methodological approach has generated both a rich dataset and a series of emotions for researchers and participants that added value to the research process. We also argue that this approach captured a greater depth of experience and diversity of voice than would have been the case if we had chosen to use traditional face-to-face methods. We call for future research to focus on better understanding some of the challenges related to the appropriateness of Facebook as a platform for hearing the voices of particular socio-cultural groups.

Pessary Plus Progesterone to Prevent Preterm Birth in Women With Short Cervixes: A Randomized Controlled Trial.

To test the effectiveness of cervical pessary in addition to vaginal progesterone for the prevention of preterm birth in women with midpregnancy short cervixes. We performed a multicenter, open-label, randomized controlled trial in 17 perinatal centers. Asymptomatic women with singleton or twin pregnancies and cervical lengths of 30 mm or less, measured at 18 0/7-22 6/7 weeks of gestation, were randomized to cervical pessary plus vaginal progesterone (pessary plus progesterone group) or vaginal progesterone only (progesterone-only group) (200 mg/day). Treatments were used from randomization to 36 weeks of gestation or delivery. The primary outcome was a composite of neonatal mortality and morbidity. Secondary outcomes were delivery before 37 weeks and before 34 weeks of gestation. Analysis was performed according to intention to treat. Between July 9, 2015, and March 29, 2019, 8,168 women were screened, of whom 475 were randomized to pessary and 461 to progesterone only. The composite perinatal outcome occurred in 19.2% (89/463) of the women in the pessary group compared with 20.9% (91/436) of the women in the progesterone-only group (adjusted risk ratio [aRR] 0.88, 95% CI 0.69-1.12). Delivery rates before 37 weeks of gestation were 29.1% compared with 31.4% (aRR 0.86, 95% CI 0.72-1.04); delivery rates before 34 weeks were 9.9% compared with 13.9% (aRR 0.66, 95% CI 0.47-0.93). Women in the pessary group had more vaginal discharge (51.6% [245/476] vs 25.4% [117/479] [P<.001]), pain (33.1% [157/476] vs 24.1% [111/479] [P=.002]), and vaginal bleeding (9.7% [46/476] vs 4.8% [22/479] [P=.004]). In asymptomatic women with short cervixes, the combination of pessary and progesterone did not decrease rates of neonatal morbidity or mortality when compared with progesterone only. Brazilian Clinical Trial Registry (ReBec), UTN:U1111-1164-2636.

Age at First Marriage and Fertility Decline in Dabat Health and Demographic Surveillance System Site, Northwest Ethiopia: Decomposition Analysis.

BackgroundFertility decline in Ethiopia has been documented since the 1990s. Amhara National Regional State has recorded the most noticeable fertility decline. However, the specific factors that explain the incipient course of fertility decline in the study area and their relative contributions were not well investigated. Hence, the purpose of this study was to determine contributing factors of fertility decline and to assess variations in fertility that can be attributed to both changes in characteristics and reproductive behaviors of women aged 15–49 years between 2008 and 2014 in Dabat Demographic and Health Surveillance Site, Northwest Ethiopia.MethodsCross-sectional censuses were carried out in a Dabat Health and Demographic Surveillance System site in 2008 and 2014. Data for 4,775 and 10,807 women of reproductive age in 2008 and 2014 were used for the analysis. A Poisson regression model was employed to assess the trends of determinants of fertility, and multivariate decomposition analysis was applied to evaluate observed changes in fertility using data from two consecutive cross-sectional censuses of Dabat HDSS.ResultsFindings indicated that there was a reduction of an average 640.69 births per 1,000 women of reproductive age during 2014 compared to 2008 in the surveillance site (95% CI=−669.5 to −582.4). This overall change in fertility was attributed to both the changing characteristics of women (76%) (95% CI=−524.74 to −453.13) and their reproductive behavior (24%) (95% CI=−224.36 to −79.14). Drivers of the recent fertility decline were increased age at first marriage, a decreased proportion of currently married women, shift in women’s birth to later age, and a higher women’s educational status.ConclusionThis study indicated that the overall reduction in fertility was attributed to both changing characteristics of women and their reproductive behavior. Major contributors to the changes in fertility were postponing women’s first marriage to a later age and changes in the proportion of currently married women over the study period. Encouraging women to complete at least secondary education is important to increase the age at first marriage and birth, which will in turn accelerate the current fertility transition.

Complement Activation Fragments in Cervicovaginal Fluid Are Associated with Intra-Amniotic Infection/Inflammation and Spontaneous Preterm Birth in Women with Preterm Premature Rupture of Membranes.

We sought to determine whether the levels of complement and other inflammatory and angiogenic mediators in cervicovaginal fluid (CVF) are independently associated with intra-amniotic infection and/or inflammation (IAI) and imminent spontaneous preterm birth (SPTB, £48 hours of sampling) in women with preterm premature rupture of membranes (PPROM). This was a retrospective study consisting of 85 singleton pregnant women with PPROM at 200/7 to 336/7 weeks. Amniotic fluid (AF) obtained via amniocentesis was cultured and assayed for interleukin-6. CVF samples collected at the time of amniocentesis were assayed for complement C3a, C4a, and C5a, HSP70 (heat shock protein 70), M-CSF (macrophage colony-stimulating factor), M-CSF-R (macrophage colony-stimulating factor-receptor), S100 A8, S100 A9, thrombospondin-2, VEGF (vascular endothelial growth factor-receptor), and VEGFR-1 (vascular endothelial growth factor-receptor 1) by enzyme-linked immunosorbent assay. Multivariate logistic regression analyses revealed that elevated CVF concentrations of complement C3a, 4a, and 5a were significantly associated with an increased risk of IAI and imminent SPTB, whereas those of M-CSF were associated with IAI, but not imminent SPTB (p = 0.063), after adjustment for baseline covariates (e.g., gestational age at sampling). However, univariate, and multivariate analyses showed that the CVF concentrations of angiogenic (thrombospondin-2, VEGF, and VEGFR-1) and inflammatory (HSP70, M-CSF-R, S100 A8, and S100 A9) proteins were not associated with either IAI or imminent SPTB. In women with PPROM, elevated CVF concentrations of complement C3a, C4a, and C5a are independently related to an increased risk of IAI and imminent SPTB. These findings suggest that complement activation in CVF is significantly involved in mechanisms underlying preterm birth and in the host response to IAI in the context of PPROM. · Elevated CVF levels of C3a, 4a and 5a are associated with IAI and SPTB.. · CVF C3a, 4a and 5a have better predictability for SPTB, compared to AF WBC.. · Elevated CVF levels of M-CSF were associated with IAI, but not SPTB..

5-Methyltetrahydrofolate and Vitamin B12 Supplementation Is Associated with Clinical Pregnancy and Live Birth in Women Undergoing Assisted Reproductive Technology

The homocysteine pathway in the preconception period should be evaluated to highlight micronutrient deficiencies and warrants optimal multivitamin supplementation, before Assisted Reproduction, as preconception care. We conducted a retrospective study aimed at investigating the role of vitamin B complex (5-methyltetrahydrofolate, vitamin B12, vitamin B6) supplement use compared with the role of only folic acid supplement use, in relation to clinical pregnancy and live birth in infertile women undergoing homologous ART. We investigated 269 Caucasian women referred to the Centre for Assisted Reproductive Technology for homologous ART. In these women, 111 (Group A) were daily supplemented with vitamin B complex and 158 (Group B) with only folic acid. In group A the mean number of Metaphase II oocytes and the 2PN Fertilization Rate were higher in comparison to group A (p = 0.04; p = 0.05, respectively). A higher percentage of women in group A had a clinical pregnancy and live birth in comparison to group B (p = 0.01; p = 0.02, respectively). Vitamin B complex supplementation remained independently associated, after multivariable adjustment, with clinical pregnancy (OR 2.03, p = 0.008) and live birth (OR 1.83, p = 0.03). Women supplemented with 5-MTHF and vitamin B12, have a higher chance of clinical pregnancy and live birth in comparison to those supplemented with only folic acid.

Women's perceptions of provider communication on birth options after cesarean: A qualitative study.

In the United States, Hispanic and non-Hispanic Black women are more likely to have a repeat cesarean birth (RCB) than non-Hispanic White women. The underrepresentation of Hispanic women and women with previous cesarean births in prior studies has resulted in a limited understanding of the reasons for this disparity. This study used in-depth interviews to investigate the perceptions of 27 Hispanic and non-Hispanic Black and White women about the communication that took place with their providers about their birth options after a previous cesarean. The roles of cultural norms and trust in providers in communication about RCBs were also explored. Results suggest that patient-provider communication and trust of providers for Hispanic and non-Hispanic Black and White women may influence their perception of choice, uptake of information, and ability to make an informed choice regarding birth options. Findings have implications for providers and healthcare management systems who need to account for and attempt to address these differences as they directly affect women's birth outcomes.

African American Women's Experiences with Birth After a Prior Cesarean Section.

Women who have had a cesarean section (C-section) and become pregnant again may choose to have a planned repeat cesarean delivery (RCD) or vaginal birth after a cesarean (VBAC). This study aimed to characterize the pregnancy and birth experiences of African American (AA) women who had a successful VBAC, failed VBAC, or RCD. Eligible participants (N = 25) self-identified as AA, had a C-section and a subsequent birth(s) in the past 12years, and were educated past high school. Each participant was individually interviewed via phone call. The Sort and Sift, Think and Shift method was used to evaluate interview transcripts to minimize researcher bias and emphasize the voices of the participants. The resulting themes included the impact of providers on pregnancy and childbirth satisfaction, the value of autonomy in maternal health decision-making, and the role that racism plays in AA women's birth experiences. Although some participants recalled a positive experience, the presence of limited autonomy, lack of support, and negative experiences with providers indicate that birth after a prior C-section for AA women can be improved. Providers should address their own racial biases and utilize the shared decision-making approach when their patients decide between a VBAC and RCD to improve patient satisfaction.