Cesarean Section: An American History of Risk, Technology, and Consequence

by Jacqueline H. Wolf

Why have cesarean sections become so commonplace in the United States? Between 1965 and 1987, the cesarean section rate in the United States rose precipitously―from 4.5 percent to 25 percent of births. By 2009, one in three births was by cesarean, a far higher number than the 5–10% rate that the World Health Organization suggests is optimal. While physicians largely avoided cesareans through the mid-twentieth century, by the early twenty-first century, cesarean section was the most commonly performed surgery in the country. Although the procedure can be lifesaving, how―and why―did it become so ubiquitous? Cesarean Section is the first book to chronicle this history. In exploring the creation of the complex social, cultural, economic, and medical factors leading to the surgery's increase, Jacqueline H. Wolf describes obstetricians' reliance on assorted medical technologies that weakened the skills they had traditionally employed to foster vaginal birth. She also reflects on an unsettling malpractice climate―prompted in part by a raft of dubious diagnoses―that helped to legitimize "defensive medicine," and a health care system that ensured cesarean birth would be more lucrative than vaginal birth. In exaggerating the risks of vaginal birth, doctors and patients alike came to view cesareans as normal and, increasingly, as essential. Sweeping change in women's lives beginning in the 1970s cemented this markedly different approach to childbirth. Wolf examines the public health effects of a high cesarean rate and explains how the language of reproductive choice has been used to discourage debate about cesareans and the risks associated with the surgery. Drawing on data from nineteenth- and early twentieth-century obstetric logs to better represent the experience of cesarean surgery for women of all classes and races, as well as interviews with obstetricians who have performed cesareans and women who have given birth by cesarean, Cesarean Section is the definitive history of the use of this surgical procedure and its effects on women's and children's health in the United States.

Genres: History

336 pages, Hardcover

Published May 15, 2018

About the author

Jackie Wolf is a professor in the Department of Social Medicine at Ohio University where she teaches classes in medical ethics and the history of medicine. Her research focuses on the history of birth and breastfeeding practices in the United States.

For many years Jackie hosted a radio show on her local NPR affiliate, WOUB, about contemporary issues in health and medicine. Her television show, HealthVision, appeared for six years on her local PBS affiliate in southeastern Ohio and western West Virginia.

Listen to her podcast, Lifespan, showcasing fascinating, personal stories about experiences with health, illness, and the healthcare system. Lifespan will debut on September 1, 2018 with stories about serious accidents, new mothers and breastfeeding, difficult diagnoses, chronic illness, end-of-life care, and more. Each episode of Lifespan will suggest how best to navigate healthcare, communicate with physicians, and cope with the aftermath of a health crisis. Subscribe to Lifespan wherever you subscribe to your favorite podcasts.

Reviews

[Hope Mullins · Rating 4 out of 5]

An eye-opener. I wish I had read this book before I became pregnant. I appreciate the education I received reading this book. I hope to pass on what I learned to my own children so they will be able to make educated decisions about their pregnancies and deliveries!