Cut It Out: The C-section Epidemic in America

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.)