Cut It Out: The C-Section Epidemic in America

Cut It Out: The C-Section Epidemic in America

Cut It Out: The C-Section Epidemic in America

Cut It Out: The C-Section Epidemic in America

Synopsis

"Engagingly written, rigorously researched, and compellingly argued, this book [is] a must-read not only for women's health advocates and scholars of reproduction, but also for those engaged in health care policy." - Susan Markens, author ofnbsp;Surrogate Motherhood and The Politics of Reproduction nbsp; nbsp;Cut It Outnbsp;examines the exponential increase in the United States of the most technological form of birth that exists: the cesarean section. While c-section births pose a higher risk of maternal death and medical complications, can have negative future reproductive consequences for the mother, increase the recovery time for mothers after birth, and cost almost twice as much as vaginal deliveries, the 2011 cesarean section rate of 33 percent is one of the highest recorded rates in U.S. history, and an increase of 50 percent over the past decade. Further, once a woman gives birth by c-section, her chances of having a vaginal delivery for future births drops dramatically. This decrease in vaginal births after cesarean sections (VBAC) is even more alarming: one third of hospitals and one half of physicians do not even allow a woman a trial of labor after a c-section, and 90 percent of women will go on to have the c-section surgery again for subsequent pregnancies. Of comparative developed countries, only Brazil and Italy have higher c-section rates; c-sections occur in only 19% of births in France, 17% of births in Japan, and 16% of births in Finland. nbsp;nbsp; How did this happen? Theresa Morris challenges most existing explanations of the unprecedented rise in c-section rates, which locate the cause of this trend in physicians practicing defensive medicine, women choosing c-sections for scheduling reasons, or women's poor health and older ages. Morris's explanation of the c-section epidemic is more complicated, taking into account the power and structure of legal, political, medical, and professional organizations; gendered ideas that devalue women; hospital organizational structures and protocols; and professional standards in the medical and insurance communities. She argues that there is a new culture within medicine that avoids risk or unpredictable outcomes and instead embraces planning and conservative choices, all in an effort to have perfect births. Based on 130 in-depth interviews with women who had just given birth, obstetricians, midwives, and labor and delivery nurses, as well as a careful examination of local and national level c-section rates,nbsp;Cut It Outnbsp;provides a comprehensive, riveting look at a little-known epidemic that greatly affects the lives, health, and families of each and every woman in America. nbsp; Theresa Morrisnbsp;is Professor of Sociology at Trinity College in Hartford, Connecticut. She is the mother of two children, the first born by c-section and the second by vaginal delivery.

Excerpt

I hate c-sections…. There’s more risk to the mother. It’s more hassle for
me, takes more of my time, more postoperative recovery, more complica
tions. I’d much rather deliver every baby vaginally if possible. There’s one
reason why the c-section rate’s up. the things that we [used to] do to help
make a vaginal delivery occur we’re not allowed to do anymore.

—Physician Jack Bianco

This book tells the story of how organizational changes constrain the decisions and behaviors of maternity providers and women in a way that has resulted in an epidemic of cesarean sections—commonly, and in this book, referred to as c-sections. Physician Bianco’s statement about the csection rate aptly represents the ideas of many maternity care providers. They feel that they cannot do “the things” they used to do to facilitate a vaginal birth. Such things include: monitoring the fetal heart rate during labor intermittently rather than continuously; encouraging women with twins and multiples, women who have had a previous c-section, or women whose baby is presenting in a breech (head-up) position to have a vaginal birth; and, most of all, optimistically waiting patiently for a vaginal birth to happen. Not all maternity providers are as passionate as Doctor Bianco, but his experience of having his decisions and actions constrained, of “not being allowed” to make decisions or follow actions he thinks would lead to a vaginal birth, are common, and maternity providers know this is making the c-section rate climb. Yet they are making the best decisions they believe they can, given the pressures they face.

Women giving birth in the United States face these constraints firsthand. Indeed, my first experience giving birth is indicative of what many . . .

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