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Cut It Out: The C-Section Epidemic in America

Cut It Out: The C-Section Epidemic in America

by Theresa Morris

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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


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 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, 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. 

Editorial Reviews

The New York Times Book Review - Jessica Valenti
…[Morris] refreshingly steers clear of the home-birthing-good, hospitals-bad dogma that tends to dominate this conversation, instead encouraging empathy with all involved…Morris's impressive research, as well as the solutions she offers to women, providers and policy planners, makes the book an important contribution to the C-section debate.
Publishers Weekly
Trinity College sociologist Morris combines a broad understanding of systemic, organizational problems and how they impact behavior with statistics and 130 interviews with maternity patients and birth professionals to examine the country’s rising C-section rate and low rate of vaginal births after cesarian (VBAC) attempts. As Morris notes, C-sections increase the risk of maternal complications while not appearing to impact birth outcomes significantly. Challenging conventional wisdom, Morris’s interviews reveal that some doctors feel their hands are tied by the legal system, for which a prompt C-section indicates that the hospital has fulfilled its responsibilities to the patient in the event of a lawsuit; hospital policies like constant fetal monitoring, which limits the movement a laboring mother needs to facilitate a vaginal birth, and the requirement that mothers who have already had cesarians cannot have vaginal births for subsequent children; and medical training that no longer teaches methods of delivering breech or multiple births vaginally. The author’s 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. Morris’s powerful book deserves the attention of policymakers. (Oct.)
From the Publisher
"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 mother's movement—and that frowns on women having vaginal births after Caesareans."- Nature
Library Journal
The United States has one of the highest Cesarean section rates in the world, and it is rising. In 2011, 33 percent of all deliveries were C-sections, a growth of 50 percent over the previous decade. The procedure carries an increased risk of medical complications and maternal death, has a much higher cost than a vaginal delivery, and necessitates a longer recovery period. Morris (sociology, Trinity Coll., CT) examines the reasons for this surge. While the literature notes that physicians are practicing defensive medicine and that women are using the procedure to schedule births at convenient times, the author posits a more complex explanation. 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. This results in conservative choices in the pursuit of the perfect birth. The author interviewed 130 new mothers, obstetricians, midwives, and labor and delivery nurses and reviewed local and national C-section rates to obtain the data for this study. VERDICT A useful addition to health sciences and academic library collections.—Barbara Bibel, Oakland P.L.

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New York University Press
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Meet the Author

Theresa Morris is Associate Professor of Sociology at Texas A&M. She is the mother of two children, the first born by c-section and the second by vaginal delivery.

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