Between 1965 and 1987 the cesarean section rate in the U.S. rose 455 percent, from 4.5 percent to 25 percent of births. While cesarean section was an appropriate and necessary procedure in a significant number of these births, the World Health Organization (WHO) has long estimated that the optimal cesarean section rate is between 5 and 10 percent of births and that a rate above 15 percent is apt to do more harm than good. Recent studies seem to corroborate WHO's assertion that the effects of a high cesarean section rate on a largely low-risk population are costly in both monetary and health terms. The proposed book will be the first in-depth social history of cesarean section in the 19th- and 20th- century U.S. and the first to examine the historical, cultural, and social issues, in addition to the medical factors, that have contributed to today's cesarean section rate of 32 percent. The book has four objectives: (1) To examine how the definition of "normal" labor and birth changed over the course of the nineteenth and twentieth centuries and to study the effect of that changing definition on lay and medical views of medical intervention during birth, particularly the performance of cesarean section. (2) To explore how standard obstetric treatment changed over this same period, particularly when medical personnel encountered a birth they deemed problematic. (3) To examine how the meaning of risk in relation to birth changed over time and to study how this change shaped medical and lay attitudes toward vaginal versus cesarean birth. (4) To study how historical, social, and cultural forces seemingly unrelated to health and medicine shape medical decisions and standard medical practices particularly in an arena such as birth, an event that represents so many societal hopes and concerns. In essence, this social history will examine the historical, social, cultural, and medical factors that shape standard obstetric practices, using cesarean section as a case study. As a historian of medicine, the P.I. will trace the social and cultural context of cesarean section over a roughly 200-year period from a time when the operation was among the most fatal of surgical procedures to the present day when the medical and lay communities view cesarean section as comparable and, at times, preferable to vaginal birth. Data for this book will be culled from oral history interviews with mothers and physicians and myriad archival and published sources including women's letters and diaries;physicians'personal papers;obstetric textbooks;articles in medical journals, newspapers, and magazines;doctors'casebooks;lying-in hospital casebooks;the papers of medical charities, home birthing services, lying-in hospitals, birth reform organizations, and medical and health insurance organizations;pregnancy and childbirth advice manuals;and physicians'and women's biographies and autobiographies.
This social history of cesarean section in the United States over the last 200 years will examine the historical, cultural, social, and medical factors that have contributed to the current cesarean section rate of 32 percent. The World Health Organization (WHO) has long estimated that the optimal cesarean section rate is between 5 and 10 percent of births and that a rate above 15 percent is apt to do more harm than good and recent studies seem to corroborate WHO's assertion that the effects of a high cesarean section rate on a largely low-risk population are costly in both monetary and health terms. A thorough exploration of the historical emergence of cesarean section as a routine surgical intervention can help clarify the reasons for the lack of an evidence-based foundation for its frequency and, in doing so, aid in mitigating the current cesarean section rate and its negative effects on women's and children's health.