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

• Published in: Medical anthropology quarterly Vol. 37; no. 4; pp. 341 - 353
• Main Author: Rubashkin, Nicholas
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.12.2023
• Subjects: algorithms; Anthropology, Medical; Births; Black or African American; Black people; cesarean birth; Cesarean section; Childbirth & labor; Counseling; Decision making; Decision Making, Shared; Ethnicity; Evidence-based medicine; Female; feminist anthropology; Gynecology; Hispanic or Latino; Humans; Maternal & child health; Obstetrics; Patients; Pregnancy; Prenatal care; Probability; Race; Racism; Vaginal birth; Vaginal Birth after Cesarean - psychology; Women; algorithms; racism; feminist anthropology; evidence-based medicine; cesarean birth
• ISSN: 0745-5194; 1548-1387
• DOI: 10.1111/maq.12784

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. I analyze how a diverse group of women and their providers engaged with the VBAC calculator. Some providers used low calculator scores to remove a shared decision‐making model by prescriptively counseling Black and Hispanic women who desired a VBAC into undergoing repeat cesareans. Consequently, women racialized by the calculator as Black or Hispanic used experiential knowledge to challenge the calculator's assessment of their supposed lesser ability to give birth vaginally.