NYU Press, (2013)
ISBN: 9780814764114 (pb)
Reviewed by Anna Neller, The University of Toledo
In Cut it Out: The C-Section Epidemic in America, Theresa Morris examines how current healthcare infrastructures such as standardized processes, hospital protocols, and minimal care guidelines have contributed to the escalation of caesarean sections (commonly known as C-sections). Morris claims the number of C-sections performed in the United States (US) is double the amount recommended by the World Health Organization (WHO) and thus throughout the book she refers to this phenomena as the “C-Section epidemic.” Morris suggests birthing techniques that were once used to facilitate vaginal births (including intermittent monitoring of fetal heart rates during labor, encouraging mothers of multiples and twins to give birth vaginally, and time flexibility to permit vaginal birth), are less likely to be employed due to rigid organizational structures constraining the decisions and behaviors of maternity providers and women.
A major strength in this book is that Morris examines an assortment of data sources and thus she achieves a multifaceted research approach for analyzing the increase of C-Sections performed. For example, she draws from two quantitative studies to explore the rise in C-Sections: the Listening to Mothers II Survey (LTMII) ‒ a national US survey of women who gave birth in 2005 ‒ and recent birthing reports conducted by the Centers for Disease Control. Additionally, using the Cochrane Collaboration Reviews, she examines evidence-based obstetrical practices. Not only does the literature provide statistical data, it also incorporates the C-Section and birthing experiences of both the maternity providers and patients. The research includes interviews of fifty obstetricians and eighty-three postpartum women. However, although the research is multidimensional, there are shortcomings. For example, readers should be aware that interviews of maternity providers and postpartum women all shared their experiences in Connecticut-based facilities ‒ which Morris acknowledges has higher C-Section and malpractice rates than other US states.
According to Morris, the value of a sociological approach is that it can highlight the ways this birthing method places women and children at an increased risk of serious health complications: “C-Sections are associated with a higher risk of injury and death to women and babies than vaginal birth” (p.14). Expanding on recent research she explains at length the possible health risks for mothers who have undergone C-Sections including increased rates of hysterectomy, re-hospitalization, and prolonged pain. Morris argues that technologies and methods used during the labor process such as the monitoring of fetal distress, the induction of labor, and medications for the control of pain are in fact main contributors for jeopardizing the well-being of mother and fetus. A key example she provides is the use of Continuous cardiotocography (CTG) ‒ which is the standard technology for monitoring fetal heart patterns. She states that recent research has shown CTG to possess a false positive rate as high as 99.8 percent (p.97). This discovery is significant since physicians often perform emergency C-Sections in order to prevent fetal and maternal danger associated with non-assuring fetal heart beats.
Despite her concern for current fetal monitor equipment’s high error rates, I am concerned that as sociologists, we may not have the necessary training, skills and qualifications to be offering de facto medical advice. The technological alternatives she offers to decrease the “unnecessary” need for C-Sections, may introduce other potential birthing complications. Some technological options she suggests for the monitoring of fetal well-being are the scalp pH tests, and the STAN test. In addition to Morris offering problematic technological remedies for reducing unwarranted C-Sections, other solutions she suggests may also be potentially dangerous. Her roadmap for reducing the rate of C-Sections could potentially exacerbate issues of poor health for postpartum women and newborns. Morris advocates for the transformation of the US healthcare system to a less medicalized system of birth. Using the Dutch obstetrical system as a model, she argues similar birthing processes like midwifery care and out-of-hospital birth should be incorporated in the US. She suggests women defined as low-risk should be encouraged to give birth at home or in birthing centers, but this logic introduces a plethora of potential health complications. First, if an emergency were to transpire during a home birth the location of the nearest hospital and the skill set of a midwife may not be conducive to such dire circumstances. Second, it is beyond the scope of this study and her sociological expertise to provide healthcare recommendations ‒ like advising women to refuse ultrasounds in the last month of pregnancy unless providers can demonstrate a high-risk condition (p.156).
Moreover, she stresses how “unnecessary” C-Sections drain the United States’ economic system. Whether this is a sound rationale for adopting different birthing practices – given the potential life and death outcomes – is debatable. Even then, the solution of home birth is unavailable to many, unless of course they have the financial resources (the majority of states do not reimburse home birthing expenses). But even if the discussion reverts to economics, highly expensive technologies like the STAN immensely increase healthcare expenditures as well. Also, she crafts a proposal for a newly refined, outcomes-based birth related injury compensation program. The aim of the program is that “All children with physical or mental birth injuries would be compensated, regardless of whether there was oxygen deprivation or mechanical injury” (p.168). A program of such magnitude would surely demand additional governmental spending and hence create a greater strain on the economy.
C-Sections are an important sociological research topic, particularly in the US. But this book seems to have a polemical emphasis on the projected negative outcomes related to C-Sections. Thus, if readers are seeking to gain more insight in the realm of obstetrical care and C-Section, this book may not offer an entirely objective outlook in this field.