Subject: Cut It Out: The C-Section Epidemic in America by Theresa Morris Cut It Out Birth by Caesarean section is expensive and carries a higher risk of medical complications than vaginal birth. Yet in 2011, 33% of US births were by Caesarean. To investigate why, sociologist Theresa Morris crunched the numbers and interviewed more than 100 medical staff and mothers. The culprit, she concludes in this excellent and detailed study, is a risk-averse US medical culture that favours heavily managed births--such as the overzealous use of fetal heart monitors, which restrict the mothers movement--and that frowns on women having vaginal births after Caesareans. The author¹s suggestions include changing insurance rules to compensate women and children with poor birth outcomes independent of fault; encouraging the use of doulas, midwives, and out-of-hospital care; counting C-section rate as a hospital quality measure; and loosening policies that reduce physician choice. Morris¹s powerful book deserves the attention of policymakers. -Publishers Weekly, Starred Review By looking at the power structures of the medical, legal, and professional organizations involved, the politics that devalue women, the organizational arrangements and protocols of hospitals, and the professional standards used in medicine and the insurance industry, she discovers a culture that avoids risk and encourages planning to avoid adverse outcomes...A useful addition to health sciences and academic library collections. -Library Journal ³Theresa Morris calls the C-section epidemic a paradox: doctors dont like it, women dont like it, and we know its a danger to our health. Yet like a bad habit, we cant seem to stop doing more and more cesareans. Why? Morris demystifies the paradox in clear, accessible terms: rather than patient choice¹ or doctors convenience, it is our systems and institutions driving this addictive behavior. Morris takes you inside those systems and institutions with a critical eye as well as a compassionate ear for the human beings caught in them, and offers concrete solutions to address this major threat to womens and babies health.² -Jennifer Block, author of Pushed: The Painful Truth About Childbirth and Modern Maternity Care Cut It Out 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. 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 women¹s poor health and older ages. Morris¹s 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, Cut It Out 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. Theresa Morris 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. New York University Press December 2013, 255pp 3 figures and 2 tables 978-0-8147-6411-4 HB £18.99
Posted on: Fri, 31 Jan 2014 14:57:28 +0000
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