After years of work by researchers, advocates and clinicians, a calculator that used race as a factor to determine the likelihood of having a successful vaginal birth after cesarean has been replaced by a newly validated version that is the same in almost every way — except for eliminating race and ethnicity as a risk factor (Source: “Changing the equation: Researchers remove race from a calculator for childbirth,” Stat News, June 3).
The previous tool takes into account a patient’s age, height, weight and history of vaginal and cesarean delivery. It also asks two yes-or-no questions: “African-American?” “Hispanic?” The answers can predict a drastically lower chance of success for patients of color. But now, that racialized calculator has been replaced by a newly validated version that does not include inputting race or ethnicity information.
The VBAC calculator is just one of several clinical algorithms that have recently been challenged over their use of race adjustment. Providers across specialties have questioned the inclusion of race and ethnicity — which are social, not biological factors — in their decision-making tools, pointing to the risk of perpetuating existing health inequities. But because obstetricians access the VBAC calculator online, it could prove much easier than with other corrected tools to get the updated calculator quickly into use across the country.
“I think it’s powerful that this is, in some ways, the first example of race correction being abandoned systematically in a tool in response to these equity concerns,” said Darshali Vyas, a resident at Massachusetts General Hospital.