EBB 396 - Inequities in VBAC Access with Dr. Nicholas Rubashkin, MD, PhD

Evidence Based Birth®

Rebecca Dekker

Kids & Family, Medicine, Parenting, Health & Fitness

4.3 • 1.1K Ratings

🗓️ 29 April 2026

⏱️ 41 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

The evidence shows that vaginal birth after cesarean (VBAC) is a safe option for many families, but it's still frequently inaccessible to them. In this episode, Dr. Rebecca Dekker and Dr. Nicholas Rubashkin discuss the systemic barriers that limit families' opportunities to choose a VBAC. They explore how hospital policies, outdated guidelines, and clinical tools like the VBAC calculator have shaped who's a "good candidate" and who is not.

Dr. Rubashkin also shares insights from his research on inequities in maternity care, including how race-adjusted algorithms reinforce disparities, why the "immediately available" standard still impacts hospital policies today, and how geography, provider practices, and induction policies can influence VBAC access. Plus, hear evidence-based strategies for advocating for a VBAC, including how to evaluate providers and interpret VBAC rates.

(01:36) Dr. Rubashkin's background and path into obstetrics
(08:32) Major barriers to VBAC access in the U.S.
(11:37) The "immediately available" standard explained
(14:38) Misconceptions about emergency cesarean availability
(16:58) Ethical and legal implications of VBAC restrictions
(18:02) Institutional barriers
(20:17) The VBAC calculator and how it influenced access
(26:12) Racism, bias, and interpretation of VBAC data
(30:02) Induction and VBAC: evidence vs. practice
(36:17) What informed consent for VBAC should include
(37:18) Identifying supportive vs. reluctant providers

Resources

ACOG's VBAC guidelines and recommendations: acog.org/clinical/clinical-guidance/practice-bulletin/articles/2019/02/vaginal-birth-after-cesarean-delivery

Human Rights in Childbirth: humanrightsinchildbirth.org/

UCSF's Better Birth Research Initiative: betterbirth.ucsf.edu/

International Cesarean Awareness Network: ican-online.org/

For more information about Evidence Based Birth® and a crash course on evidence based care, visit www.ebbirth.com. Follow us on Instagram and YouTube! Ready to learn more? Grab an EBB Podcast Listening Guide or read Dr. Dekker's book, "Babies Are Not Pizzas: They're Born, Not Delivered!" If you want to get involved at EBB, join our Professional membership (scholarship options available) and get on the wait list for our EBB Instructor program. Find an EBB Instructor here, and click here to learn more about the EBB Childbirth Class.

Transcript

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0:00.0	Hi everyone. On today's podcast, we're going to talk with Dr. Nicholas Rabashkin about inequities and VBAC access.
0:10.7	Welcome to the evidence-based birth podcast. My name is Rebecca Decker, and I'm a nurse with my PhD and the founder of evidence-based birth.
0:19.0	Join me each week as we work together to get evidence-based
0:22.5	information into the hands of families and professionals around the world. As a reminder,
0:28.0	this information is not medical advice. See eBbirth.com slash disclaimer for more details.
0:35.7	Hi, everyone, and welcome to today's episode of the evidence-based birth podcast.
0:40.0	Today, I am so excited to have Dr. Nicholas Rabashkin with me to talk about V-BAC access.
0:45.8	Dr. Nicholas Rabashkin has his MD, as well as his PhD in Global Health, and he is an
0:51.4	associate professor in the Department of Obstetrics, Gynaecology, and Reproductive Sciences
0:55.9	at the University of California, San Francisco, where he works as an obstetric hospitalist.
1:01.8	Dr. Abashkin's dissertation research examined the ways in which a race-adjusted clinical algorithm,
1:08.0	which was called a vaginal birth after cesarean calculator or VBAC calculator,
1:13.8	reproduced racism in the United States maternity care. Since 2022, he has been a women's
1:19.1	reproductive health research scholar at UCSF, conducting NIH-funded research on equitable access
1:26.0	to VAC in California, and Dr. Rabashkin also serves on the board of the international nonprofit, human rights, and childbirth. Dr. Robashkin, welcome to the evidence-based birth podcast. Thank you so much. I'm really excited to be here today. As a OB-Care provider, I've often shared your evidence summaries with women, family. So I'm thrilled to be
1:45.3	here. I really admire of your work. Thanks. Yeah. And we always love having an OB advocate on the
1:50.8	podcast to keep meeting more and more of you out there. So can you tell us a little bit about like
1:56.7	what brought you into this field in the first place? Yeah. How I often tell this story is I actually had considered obstetrics until I did the
2:06.3	rotation in medical school, which was kind of surprising because birth was a really big topic
2:12.2	in my family.
2:13.1	My mom was one of nine children and her mother gave birth to her during the era of Twilight Sleep
2:20.3	and had nine children unconscious. And I was born at home, which was a normal place to be
	...

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