Automating Racism: Is Use of the Vaginal Birth After Cesarean Calculator Associated with Inequity in Perinatal Service Delivery?

Objective: The clinical application of race-adjusted algorithms may perpetuate health inequities. We assessed the impact of the vaginal birth after cesarean (VBAC) calculator, which was revised in 2021 to address concerns about equity. The original algorithm factored race and ethnicity and gave lower VBAC probabilities to Black and Hispanic patients.

In search of respect and continuity of care: Hungarian women's experiences with midwifery-led, community birth.

Introduction: To describe and compare intervention rates and experiences of respectful care when Hungarian women opt to give birth in the community.

Methods: We conducted a cross-sectional online survey (N = 1257) in 2014. We calculated descriptive statistics comparing obstetric procedure rates, respectful care indicators, and autonomy (MADM scale) across four models of care (public insurance; chosen doctor or chosen midwife in the public system; private midwife-led community birth).

Patient-Led Approaches to a Vaginal Birth After Cesarean Delivery Calculator.

Objective: To describe patient approaches to navigating their probability of a vaginal birth after cesarean (VBAC) within the context of prediction scores generated from the original Maternal-Fetal Medicine Units' VBAC calculator, which incorporated race and ethnicity as one of six risk factors.

Methods: We invited a diverse group of participants with a history of prior cesarean delivery to participate in interviews and have their prenatal visits recorded. Using an open-ended iterative interview guide, we queried and observed these individuals' mode-of-birth decisions in the context of their VBAC calculator scores.

Epistemic Silences and Experiential Knowledge in Decisions After a First Cesarean: The case of a vaginal birth after cesarean calculator.

Evidence-based obstetrics can employ statistical models to justify greater use of cesareans, sometimes excluding experiential elements from informed decision making. Over the past decade, prenatal providers adopted a vaginal birth after cesarean (VBAC) calculator designed to support patients in making informed decisions about their births by estimating their probability for a VBAC. Among other factors, the calculator used race and ethnicity to make its estimate, assigning lower probabilities for a successful VBAC to Black and Hispanic patients.

Birth includes us: Development of a community-led survey to capture experiences of pregnancy care among LGBTQ2S+ families.

Background: Limited research captures the intersectional and nuanced experiences of lesbian, gay, bisexual, transgender, queer, two-spirit, and other sexual and gender-minoritized (LGBTQ2S+) people when accessing perinatal care services, including care for pregnancy, birth, abortion, and/or pregnancy loss.

Methods: We describe the participatory research methods used to develop the Birth Includes Us survey, an online survey study to capture experiences of respectful perinatal care for LGBTQ2S+ individuals. From 2019 to 2021, our research team in collaboration with a multi-stakeholder Community Steering Council identified, adapted, and/or designed survey items which were reviewed and then content validated by community members with lived experience.

Why Equitable Access to Vaginal Birth Requires Abolition of Race-Based Medicine.

In 2010, the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network developed a decision aid, the Vaginal Birth After Cesarean (VBAC) calculator, to help clinicians discern how one variable (race) might influence patients' success in delivering a baby vaginally following a prior birth by cesarean. The higher rate of cesarean deliveries among Black and Hispanic women in the United States has long demonstrated racial inequities in obstetrical care, however. Although the MFMU's new VBAC calculator no longer includes race or ethnicity, in response to calls for abolition of race-based medicine, this article argues that VBAC calculator use has never been race neutral.

Trends in Home Birth Information Seeking in the United States and United Kingdom During the COVID-19 Pandemic.

This cross-sectional study used online search data to assess changes in home birth information-seeking behaviors across the United States and United Kingdom during the COVID-19 pandemic.

Examining obstetric interventions and respectful maternity care in Hungary: Do informal payments for continuity of care link to quality?

Background: In Hungary, 60% of women pay informally to secure continuity with a "chosen" provider for prenatal care and birth. It is unclear if paying informally influences quality of maternity care. This study examined associations between incentivized continuity care models and obstetric procedures and respectful care.

The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States.

Background: Recently WHO researchers described seven dimensions of mistreatment in maternity care that have adverse impacts on quality and safety. Applying the WHO framework for quality care, service users partnered with NGOs, clinicians, and researchers, to design and conduct the Giving Voice to Mothers (GVtM)-US study.

Methods: Our multi-stakeholder team distributed an online cross-sectional survey to capture lived experiences of maternity care in diverse populations.

"Just a little help": A qualitative inquiry into the persistent use of uterine fundal pressure in the second stage of labor in Spain.

Introduction: Uterine fundal pressure, or the Kristeller maneuver (KM), is a non-evidence-based procedure used in the second stage of labor to physically force the fetus to delivery. Even though officially banned, the KM is practiced in 25% of vaginal deliveries in Spain.

Methods: Using semi-structured interviews (N = 10 women, N = 15 midwives, N = 3 obstetricians), we sought to understand how providers justify using the KM, and to describe the current circumstances in which the KM is practiced.

A systematic review of person-centered care interventions to improve quality of facility-based delivery.

Introduction: We conducted a systematic review to summarize the global evidence on person-centered care (PCC) interventions in delivery facilities in order to: (1) map the PCC objectives of past interventions (2) to explore the impact of PCC objectives on PCC and clinical outcomes.

Methods: We developed a search strategy based on a current definition of PCC. We searched for English-language, peer-reviewed and original research articles in multiple databases from 1990 to 2016 and conducted hand searches of the Cochrane library and gray literature.

How Should Trainees Respond in Situations of Obstetric Violence?

Argentina passed a law for humanized birth in 2004 and another law against obstetric violence in 2009, both of which stipulate the rights of women to achieve respectful maternity care. Clinicians and women might still be unaware of these laws, however. In this article, we discuss the case of a fourth-year medical student who, while visiting Argentina from the United States for his obstetric rotation, witnesses an act of obstetric violence.

The Mothers on Respect (MOR) index: measuring quality, safety, and human rights in childbirth.

Background: Abuse of human rights in childbirth are documented in low, middle and high resource countries. A systematic review across 34 countries by the WHO Research Group on the Treatment of Women During Childbirth concluded that there is no consensus at a global level on how disrespectful maternity care is measured. In British Columbia, a community-led participatory action research team developed a survey tool that assesses women's experiences with maternity care, including disrespect and discrimination.

Assessing quality of maternity care in Hungary: expert validation and testing of the mother-centered prenatal care (MCPC) survey instrument.

Background: Instruments to assess quality of maternity care in Central and Eastern European (CEE) region are scarce, despite reports of poor doctor-patient communication, non-evidence-based care, and informal cash payments. We validated and tested an online questionnaire to study maternity care experiences among Hungarian women.

Methods: Following literature review, we collated validated items and scales from two previous English-language surveys and adapted them to the Hungarian context.

Informal cash payments for birth in Hungary: Are women paying to secure a known provider, respect, or quality of care?

Background: In Central and Eastern Europe, many women make informal cash payments to ensure continuity of provider, i.e., to have a "chosen" doctor who provided their prenatal care, be present for birth.

The Mother's Autonomy in Decision Making (MADM) scale: Patient-led development and psychometric testing of a new instrument to evaluate experience of maternity care.

Objective: To develop and validate a new instrument that assesses women's autonomy and role in decision making during maternity care.

Design: Through a community-based participatory research process, service users designed, content validated, and administered a cross-sectional quantitative survey, including 31 items on the experience of decision-making.

Setting And Participants: Pregnancy experiences (n = 2514) were reported by 1672 women who saw a single type of primary maternity care provider in British Columbia.