A recent study has uncovered a concerning trend in the field of obstetrics: healthy Black women with low-risk pregnancies are significantly more likely to undergo cesarean sections compared to their white counterparts with similar medical histories. Joel Bervell, known as the “medical myth buster,” shared insights in a TikTok from a comprehensive study analyzing medical records of nearly one million women who gave birth between 2008 and 2017.
The study’s findings are stark: “Even if a Black mother and a white mother with similar medical histories went to the same doctor at the same hospital, the black mother was 20 percent more likely to have her baby via c-section,” Bervell reports. While the study authors proposed several potential explanations, including provider biases and financial incentives, Bervell highlights a critical factor that he believes was overlooked in the analysis.
This missing piece, according to Bervell, relates to “clinical algorithms like the VBAC calculator and how we’re taught to actually think about race in the field of medicine.” The VBAC (Vaginal Birth After Cesarean) calculator is a tool used by clinicians to estimate the likelihood of a successful vaginal birth for women who have previously undergone a c-section.
@joelbervell A new study from this month is showing that healthy Black women with low risk-factors are 20% more likely to get C-sections than white women with similar medical histories. While authors provided some reasons why, I can’t help but think about the way in which race is taught in the field of medicine contrinbuted to this disparity. One example I often us is tools like the VBAC calculator, which is a tool used by doctors to estimate an individual’s chances of a successful vaginal birth after previously getting a cesarean delivery (C-section). The algorithm, however, had a built in factor that deducted points specifically if a person was Black or Latina. That made it less likely for this population to be offered a VBAC, and more likely to receive a C-Section. Biases and calculators like these highlight how race-based medicine can lead to unequal care. #joelbervell #medicalmythbuster #tiktokpartner #tiktokforgood #pregnancy
However, Bervell points out a troubling aspect of this algorithm: “The algorithm, however, deducted points specifically if a person was African American or Hispanic.” This bias built into the calculator made it “harder for this population to receive a vaginal birth and more likely to get a c-section.” The impact of this racial factor was significant, with Bervell noting that “even if the only factor that was changed was race, that could affect the estimate by up to 15 percent.”
It wasn’t until 2021 that a new version of the calculator was created, eliminating race as a factor and instead using “a more objective factor, previous treatment for hypertension or high blood pressure.” This change represents a step towards more equitable health care, but also highlights the persistence of racial biases in medical tools and practices.
Bervell concludes with a powerful statement on the importance of critically examining medical practices and tools: “The truth is medicine is not immune to the biases that we carry. If we don’t actively question the tools and systems that we use, we risk perpetuating equities that harm patients simply because of their race.”
A C-section is a surgical procedure where a baby is delivered through an incision in the mother’s abdomen and uterus. This is typically done when vaginal delivery is not possible or safe.
The higher rate of C-sections among Black women is a complex issue with multiple contributing factors. While some of these factors are medical, others are rooted in systemic racism and implicit biases within the health care system.
There are several reasons why a C-section might be necessary, including:
- Maternal health conditions: Preeclampsia, heart disease, or diabetes can increase the risk of complications during vaginal delivery.
- Fetal distress: If the baby’s heart rate is abnormal or there are other signs of distress, a C-section may be necessary.
- Breech presentation: If the baby is positioned feet-first or bottom-first, a C-section is usually recommended.
- Multiple births: Twins or triplets are more likely to be delivered via C-section, especially if the first baby is breech.
- Previous C-section: Having a previous C-section generally increases the risk of complications with subsequent pregnancies, and a repeat C-section is often recommended.
- Placenta previa: When the placenta is positioned over or near the cervix, it can block the baby’s passage and require a C-section.
This study and Bervell’s analysis serve as a crucial reminder of the ongoing need to address racial disparities in healthcare. By identifying and correcting biases in medical algorithms and practices, the medical community can work towards providing more equitable care for all patients, regardless of race.