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The Maternal Fetal Medicine Units (MFMU) Vaginal Birth After Cesarean (VBAC) Calculator: statistics and ‘race’ in an ethnography of obstetric thinking
Dissertation presentation by Nicholas Rubashkin, MD, MA, PhD(c)
Doctor of Philosophy in Global Health Sciences
By 2015, the global cesarean rate had risen to 21% of all births. After a first cesarean, most women worldwide will have a repeat cesarean for their next birth, as compared to having a Vaginal Birth After Cesarean (VBAC). Due to the escalating morbidity of sequential cesarean surgeries, the NIH has recommended increasing the VBAC rate be a public health priority.
This dissertation used ethnographic methods to critically evaluate the invention of the VBAC calculator and assess the impact of the calculator on the pregnancy and birth experiences of a diverse group of women in the U.S. Dr. Rubashkin’s first paper argues that the calculator ran counter to the ways in which many women experienced pregnancy as an embodied and unfolding process. His second paper examines how the VBAC calculator automated the reproduction of racism. His third paper uses ethnographic data to analyze non-numeric inputs that women incorporated when deciding to plan a VBAC or schedule a repeat cesarean.