When a woman gives birth by cesarean section, a nationally accepted standard typically helps decide whether she’ll need the same procedure next time; but within the University of Maryland Medical System, race and ethnicity will no longer be part of calculations used to determine that.
“This is important for all of the algorithms, practice guidelines and calculators that we’re examining, reexamining here,” said Dr. Joseph L. Wright, vice president and chief health equity officer for UMMS.
He said the Vaginal Birth After Cesarean (VBAC) calculator does not need to consider a woman’s skin color.
“There’s a long, sordid history here about a belief in the actual pelvic architecture of women of color, compared to what is known as a gynecoid pelvis, which is the standard against which the other shapes of pelvis were deemed to be less amenable to, say vaginal delivery,” Wright said.
UMMS’ revised Vaginal Birth After Cesarean calculator, known as VBAC 2.0, is endorsed by the American College of Obstetricians and Gynecologists that explains its rationale as follows:
“Given the increasing recognition that differences in outcome by race are not biologically based but rather reflect the impact of systemic racism, social determinants of health, and clinician bias, utilizing race and ethnicity variables in a VBAC (vaginal birth after cesarean) calculator may deter patients and clinicians from TOLAC (trial of labor after cesarean) without biologic cause and thereby reinforce inequity rather than support patient-centered care,” the group’s website states.
Wright said the move reflects a moment of dramatic change.
“This is an awakening,” he said. “And, it’s not just in this case of the obstetric community here. There are certainly other examples where race has been inappropriately inserted as a decision-making variable.”
The University of Maryland Medical System is committed to addressing each instance of inappropriate use of racial considerations within every medical disciple, which Wright acknowledges will be a “heavy lift.”
“I’m not going to be unrealistic about that because we didn’t get here overnight. Again, many of these variables have been embedded for decades, if not hundreds of years, and we’re not going to fix it overnight. But, I’m glad that we’re getting started,” Wright said.
The system implemented a race-free algorithm used to evaluate kidney function in February.