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.
Here are a few examples of how racism impacts Black women and birthing people:
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.
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 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
Our mission is to increase access to VBAC and we believe that VBAC should be truly accessible for all.
We stand in solidarity with BIPOC people working to make birth safer in their communities.
For organizations like ours, it is both a sacrifice and a blessing to award scholarships. We believe every birth professional, woman, and birthing person should have access to the critical information our curriculum provides, without resources becoming a barrier.
It is one thing we can all do to assure members of our diverse community have equal access, and fewer barriers, to successful VBACs. Birth-workers of color are an integral part of that work and are on the frontlines.
VBAC Facts® hopes to someday have a major donor/partner willing to sponsor even more VBAC scholars in the future. (If you are interested in supporting our mission in this way, let's talk!)
In the meantime, we will continue to offer scholarship applications for people of color, to join our program and our fight to gain and maintain equitable access to VBACs.
You can make a contribution in the amount of your choosing via PayPal or select an option below.
To inquire about a BIPOC scholarship, please contact us.
"VBAC Facts® supports my Evidence Based practice as a Black Birth Doula. The material is easy to comprehend and share with my clients and peers. Here in NYC I am welcomed for embracing the evidence. VBAC Facts highlights information that others avoid. This information is empowering to Black and BIPOC families/peers."
- Denise Bolds, Founder, Bold Doula