Cut It Out

Starred review from July 29, 2013
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.

September 15, 2013

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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