It is virtually impossible for anyone who was raised in a white colonialist country – like the United States – to come into adulthood without racism in their heart and mind. This is where implicit bias comes from. So if you have heard people say things like, “All white people are racist,” that’s what they are referring to. It’s not using the N-word or going to a KKK rally. It’s not listening to Black women when they report pain in the hospital and missing a potentially deadly complication as a result. That is one way implicit bias presents. So what can white birth professionals do about it? How can they identify and face the implicit bias in their own heart, and systemic racism within the health care system, so racial disparities can improve?
An advocate claims that the American College of Obstetricians & Gynecologists (ACOG) said VBAC after more than one prior cesarean (VBAMC) doesn’t pose an increased risk. A reader contacted me asking if this was correct. It is not. ACOG does not say that because it’s not true.
VBAC calculators have been embraced with open arms by some providers, whereas others reject them altogether. Who’s right? Trying to predict who will have a VBAC is tricky. We know some individual factors, such as having a prior vaginal delivery, are associated with higher or lower VBAC rates. By combining various factors, VBAC calculators generate a percentage that represents the best guess for an individual’s odds of having a vaginal birth after cesarean. But VBAC calculators, also called VBAC success calculators, are not always accurate and can create emotional baggage.
In 2011 a woman with two prior cesareans named Rinat Dray was forced to have a cesarean at Staten Island University Hospital in New York. She sued the hospital and two physicians for ‘improperly substituting their judgement for that of the mother’ and ‘pressuring and threatening her.’ During the course of her lawsuit, it was revealed that this hospital had a secret forced cesarean policy. When I learned about this policy, I was shocked. Yes, forced cesareans happen. They are woven into the culture of some hospitals as are other forms of obstetric violence. But to have a formal, written policy saying that it was OK?