Medicalization of birth: The social construction of Cesarean section: A qualitative analysis

The Cesarean birth rate in the United States is nearly 32%, among the highest in the world. Yet, there has not been a comparable decrease in infant mortality. Cesarean rates keep increasing, but we do not know how or why.;Most research looks to medical experts for insight. This study asks women who have cesareans how they explain them. Usually, studies of American birth experiences are limited to middle class women (Davis-Floyd, 1992). This study compares the cesarean experiences of middle class women with the experiences of poorer women, using possession of private insurance or Medicaid coverage as an indicator of socioeconomic status.;In-depth, face to face interviews were done with 32 low risk women who had cesareans about six weeks earlier. Interviews were divided into three empirical categories depending on how women viewed their cesarean: as something they requested, agreed to have, or tried to avoid.;Contrary to claims in recent medical literature about women's requests for cesarean section, the women in this study asked for cesarean only when they believed vaginal birth would cause serious harm to them or their babies, or after their attempts at vaginal delivery failed. Doctors tended to resist women's requests for cesarean. Some women were told that they "could die from cesarean section". When doctors declined to perform cesarean sections it was usually for women with Medicaid.;Women who agreed to cesarean sections typically did not understand the seriousness of the surgery and assumed that cesarean section would be quicker and less painful than vaginal delivery. For some women, cesarean section was viewed as a way to end labor, to "get it over with" or as a way to turn over responsibility for the outcome to doctors. Women were surprised at post-operative pain and limitations on their movements that affected their ability to care for their infants.;With two exceptions, the choices about cesarean were framed for agree-ers by the professionals. Often women were simply asked to choose between cesarean section and compromising the health of their babies.;Most women who wanted to avoid cesarean were able to do so when their babies were not in distress. Women used a variety of creative strategies and some were willing to endure severe pain to avoid cesarean section. Husbands or boyfriends may or may not behave in ways that are supportive. Women who had a doctor who supported vaginal birth after cesarean or who were able to negotiate with doctors around cesarean were better able to achieve their goal of vaginal delivery.;Perhaps no form of obstetrical care has been as debated as cesarean section, but the debates exclude those who are most affected by the problem---the women themselves. This dissertation has been an attempt to give voice to these women. Their experiences suggest a need for developing and using alternatives to the medicalized model used in the United States.