Racism is our legacy
Racism and White supremacy are the foundation upon which the United States was built and continues to harm Black people.
One of the places we see the most harm is within the medical system. Health care is fraught with bias driven by deeply rooted racist ideologies.
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If you are a BIPOC person interested in a scholarship for VBAC Facts professional membership or "The Truth About VBAC for Families," please contact us for more information.
Here are a few examples of how racism impacts Black women and birthing people:
More Complications
Having a higher rate of complications, near misses, and death during pregnancy, childbirth, and postpartum (including Black women in wealthy neighborhoods)
Preterm Births
Having a higher rate of preterm birth - this quote is especially poignant: "The lifelong accumulated experiences of racial discrimination by African American women constitute an independent risk factor for preterm delivery." (Source)
Being Dismissed
Being dismissed when you report pain or symptoms, like what happened to Serena Williams (scroll down to "The impact of racism on VBAC odds" here) or read about April Valentine's death as a result of staff ignoring her reports of pain for hours
There is an abundance of research out there - in addition to the many Black voices talking about racism - which is why it's frustrating when some claim racism is over in the US. It's not.
What does this have to do with vaginal birth after cesarean (VBAC?)
Numerous studies have documented that Black people are more likely to have a repeat cesarean, and less likely to have a VBAC, than White people.
Here are just a few:
Mirabal-Beltran (2020). Birth Mode after Primary Cesarean among Hispanic and non-Hispanic Women at One U.S. Institution.
This study looked at the connection between repeat cesarean delivery rates and race/ethnicity. They found that Black birthing people have 2.8 times higher odds of having a repeat cesarean than White women. "Further work is needed to fully understand the reasons for these differences, particularly the extent to which patient–provider interaction and provider bias play a role in explaining the differences."
Fore (2019). Outcomes of trial of labor after cesarean birth by provider type in low‐risk women.
In comparison to Hispanic birthing people who labored after a cesarean, Black people had almost 2.5 times higher odds of having an unplanned repeat cesarean.
Attanasio (2019). Correlates of Trial of Labor and Vaginal Birth After Cesarean in the United States.
This study examines birth certificate data in the United States for 2016. They state, "about 23% of women had a TOLAC, and 74% of women with a TOLAC gave birth vaginally. Black women had higher odds of TOLAC relative to White women, but lower odds of successful VBAC."
Wu (2019). Factors associated with successful vaginal birth after a cesarean section: a systematic review and meta-analysis.
This meta-analysis of 94 studies examines how various factors impact VBAC odds. They found that Black birthing people have about half the odds of having a VBAC in comparison to White birthing people.
Edmonds (2015). Variation in Vaginal Birth After Cesarean by Maternal Race and Detailed Ethnicity.
This study focuses on the odds of having a VBAC in Massachusetts. They report that Black birthing people are slightly less likely than White birthing people to have a VBAC.
Creaney (2011) The Effect of Obesity & Ethnic Origin on VBAC Success Rates: A Retrospective Audit from St Thomas' Hospital.
This study measured VBAC rates at one hospital in London. Of the people who planned VBACs, the VBAC rate among White birthing people was 68.1% versus 55.4% among Black birthing people.
Hollard (2006). Ethnic disparity in the success of vaginal birth after cesarean delivery.
This study looks specifically at the impact of race/ethnicity on VBAC rates. They found that labor after cesarean rates are similar among White, Hispanic, and Black birthing people with rates of 46.6%, 45.4%, and 46.0% respectively. But that changes when we look at who actually has a VBAC. 79.3% of White and Hispanic people had a VBAC whereas only 70% of Black people did. The study concludes, "African American and Hispanic women are significantly less likely than Caucasian women to achieve successful VBAC."
If you serve communities of color, you may know that the Grobman 2007 VBAC calculator deducts points if your client is Black or Latinx. This deduction for race and ethnicity may give birthing people of color an inaccurate perception of their VBAC odds.
This deduction originates from the Grobman 2007 study, which reported the odds of Black and Latinx people having a VBAC is half that of white people.
However, these lower odds in all of these studies are less a reflection of one’s innate ability to birth and more of a reflection of how institutionalized racism and implicit bias impacts the delivery of healthcare in the United States.
As Congresswoman Shirley Chisholm said:
“Racism is so universal in this country, so widespread, and deep-seated, that it is invisible because it is so normal.”
professional membership gives me confidence
Professional membership gives me confidence in supporting my personal clients through vaginal deliveries. But more importantly, I understand so much more about the risks of any kind of birth following a c-section. There’s also the ability to share this resource with every doula I have the privilege of working alongside towards birth justice.
- Kairis Chiaji
National Doula Trainer, Birthing Project USA
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If you are a BIPOC person interested in a scholarship for VBAC Facts professional membership or "The Truth About VBAC for Families," please contact us for more information.