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Fear, Risk, and the Responsible Choice: Risk Narratives and Lowering the Rate of Caesarean Sections in High-income Countries

1 School of Public Administration, University of Victoria, Victoria BC, Canada
2 Department of Gender Studies, University of Victoria, Victoria BC, Canada
3 School of Social and Political Sciences, University of Melbourne and Australia and New Zealand School of Government
4 Department of Sociology and the Canadian Institute of Substance Use Research, University of Victoria, Victoria BC, Canada

Special Issues: Cultural Narratives in Health

In Canada, as elsewhere in the world, caesarean sections are the most common surgical procedure performed in hospitals annually. Recent national statistics indicate 28% of infants in Canada are born by c-section while in the United States that number rises to 33%. This is despite World Health Organization recommendations that at a population level only 10–15% of births warrant this form of medical intervention. This trend has become cause for concern in recent decades due to the short and long-term health risks to pregnant women and infants, as well as the financial burden it places on public health care systems. Others warn this trend may result in a collective loss of cultural knowledge of a normal physiological process and, in the process, establish a new “normal” childbirth. Despite a range of interventions to curb c-section rates—enhanced prenatal care and innovation in pregnancy monitoring, change in hospital level policies, procedures and protocols, as well as public education campaigns—they remain stubbornly resistant to stabilization, let alone, reduction in high-income countries. We explore—through a review of the academic and grey literature—the role of cultural and social narratives around risk, and the responsibilization of the pregnant woman and the medical practitioner in creating this kind of resistance to intervention today.
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References

1. Gibbons L, Belizán JM, Lauer JA, et al. (2010) The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. World Health Rep 30: 1-31.

2. Bailit JL, Love TE, Mercer B (2004) Rising cesarean rates: Are patients sicker? Am J Obstet Gynecol 191: 800-803.    

3. Cyr RM (2006) Myth of the ideal cesarean section rate: Commentary and historic perspective. Am J Obstet Gynecol 194: 932-936.    

4. Todman D (2007) A history of caesarean section: From ancient world to the modern era. Aust NZ J Obstet Gynaecol 47: 357-361.    

5. Petitti DB (1985) Maternal Mortality and Morbidity in Cesarean Section. Clin Obstet Gynecol 28: 763-769.    

6. Reynolds E (1907) Primary operations for obstetrical debility. Surg Obstet Gynecol 4: 306-318.

7. Betran AP, Torloni MR, Zhang J, et al. (2015) What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health 12: 57.

8. Betrán AP, Ye J, Moller A-B, et al. (2016) The increasing trend in caesarean section rates: global, regional and national estimates: 1990-2014. PloS One 11: e0148343.    

9. McFarlin BL (2004) Elective cesarean birth: issues and ethics of an informed decision. J Midwifery Women's Health 49: 421-429.    

10. Leslie MS (2004) Counseling women about elective cesarean section. J Midwifery Women's Health 49: 155-159.    

11. Munro S, Kornelsen J, Hutton E (2009) Decision making in patient‐initiated elective cesarean delivery: The influence of birth stories. J Midwifery Women's Health 54: 373-379.    

12. Esteves-Pereira AP, Deneux-Tharaux C, Nakamura-Pereira M, et al. (2016) Caesarean Delivery and Postpartum Maternal Mortality: A Population-Based Case Control Study in Brazil. PloS One 11: e0153396.    

13. Althabe F, Sosa C, Belizán JM, et al. (2006) Cesarean Section Rates and Maternal and Neonatal Mortality in Low-, Medium-, and High-Income Countries: An Ecological Study. Birth 33: 270-277.    

14. Fenwick J, Staff L, Gamble J, et al. (2010) Why do women request caesarean section in a normal, healthy first pregnancy? Midwifery 26: 394-400.    

15. CIHI (2006) Giving Birth in Canada: The Costs. In: Research C, editor. Ottawa Ontario: CIHI.

16. PHAC (2013) Perinatal Health Indicators for Canada 2013. In: Canada PHAo, editor. Ottawa: Public Health Agency of Canada.

17. Van Wagner V (2016) Risk talk: Using evidence without increasing fear. Midwifery 38: 21-28.    

18. Barer ML, Stoddart GL (1999) Improving Access to Needed Medical Services in Rural and Remote Canadian Communities: Recruitment and Retention Revisited. In: Resources FPTACoHH, editor. Ottawa: Federal/Provincial/Territorial Advisory Committee on Health Human Resources.

19. Main E, Morton C, Hopkins D, et al. (2011) Cesarean deliveries, outcomes, and opportunities for change in California: toward a public agenda for maternity care safety and quality. California Medical Quality Care Collaborative White Paper.

20. Kennedy HP, Grant J, Walton C, et al. (2010) Normalizing birth in England: a qualitative study. J Midwifery Women's Health 55: 262-269.    

21. Hartmann KE, Andrews JC, Jerome RN, et al. (2012) Strategies To Reduce Cesarean Birth in Low-Risk Women. In: Quality AfHCRa, editor. Rockville, MD: U.S. Department of Health and Human Services, 1-65.

22. Chaillet N, Dumont A (2007) Evidence‐based strategies for reducing cesarean section rates: a meta‐analysis. Birth 34: 53-64.    

23. Walker R, Turnbull D, Pratt N, et al. (2005) The development and process evaluation of an information‐based intervention for pregnant women aimed at addressing rates of caesarean section. BJOG: Int J Obstet Gynaecol 112: 1605-1614.    

24. Link BG, Phelan JC (2006) Stigma and its public health implications. Lancet 367: 528.    

25. Kennedy HP, Grant J, Walton C, et al. (2013) Elective caesarean delivery: A mixed method qualitative investigation. Midwifery 29: e138-e144.    

26. Chaillet N, Dubé E, Dugas M, et al. (2007) Identifying barriers and facilitators towards implementing guidelines to reduce caesarean section rates in Quebec. Bull W H O 85: 791-797.    

27. Sandall J, Soltani H, Gates S, et al. (2016) Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews.

28. Lynn Bourgeault I, Declercq E, Sandall J, et al. (2008) Too Posh To Push? Comparative perspectives on maternal request caesarean sections in Canada, the US, the UK and Finland. Patients, consumers and civil society. Emerald Group Publishing Limited, 99-123.

29. Hammer RP, Burton-Jeangros C (2013) Tensions around risks in pregnancy: A typology of women's experiences of surveillance medicine. Soc Sci Med 93: 55-63.    

30. Armstrong D (1995) The rise of surveillance medicine. Sociol Health Illn 17: 393-404.    

31. Krieger N, Fee E (1994) Man-Made Medicine and Women's Health: The Biopolitics of Sex/Gender and Race/Ethnicity. Int J Health Serv 24: 265-283.    

32. Giddens A (1998) Risk society: the context of British politics. The politics of risk society, 23-34.

33. Beck U (1992) Risk society: Towards a new modernity. Soc Forces 73.

34. Jarvis DSL (2007) Risk, Globalisation and the State: A Critical Appraisal of Ulrich Beck and the World Risk Society Thesis. Global Soc 21: 23-46.    

35. Kasperson RE, Renn O, Slovic P, et al. (1988) The Social Amplification of Risk: A Conceptual Framework. Risk Anal 8: 177-187.    

36. Dean M (1998) Risk, Calculable and Incalculable. Soz Welt 49: 25-42.

37. Bisits A (2016) Risk in obstetrics–Perspectives and reflections. Midwifery 38: 12-13.    

38. Kringeland T, Möller A (2006) Risk and security in childbirth. J Psychosom Obstet Gynecol 27: 185-191.    

39. Westfall RE, Benoit C (2004) The rhetoric of "natural" in natural childbirth: childbearing women's perspectives on prolonged pregnancy and induction of labour. Soc Sci Med 59: 1397-1408.    

40. Skinner J, Maude R (2016) The tensions of uncertainty: Midwives managing risk in and of their practice. Midwifery 38: 35-41.    

41. Bauer S, Olsén JE (2009) Observing the others, watching over oneself: Themes of medical surveillance in post-panoptic society. Surveill Soc 6: 116-127.

42. Hallgrimsdottir HK, Benner BE (2014) 'Knowledge is power': risk and the moral responsibilities of the expectant mother at the turn of the twentieth century. Health Risk Soc 16: 7-21.    

43. Williams C (2005) Framing the fetus in medical work: rituals and practices. Soc Sci Med 60: 2085-2095.    

44. Roberts J (2016) The visualised foetus: A cultural and political analysis of ultrasound imagery: Routledge.

45. Benoit C, Stengel C, Marcellus L, et al. (2014) Providers' constructions of pregnant and early parenting women who use substances. Sociol Health Illn 36: 252-263.    

46. Markens S, Browner CH, Mabel Preloran H (2010) Interrogating the dynamics between power, knowledge and pregnant bodies in amniocentesis decision making. Sociol Health Illn 32: 37-56.    

47. Burton-Jeangros C (2011) Surveillance of risks in everyday life: The agency of pregnant women and its limitations. Soc Theory Health 9: 419-436.    

48. Scamell M (2016) The fear factor of risk–clinical governance and midwifery talk and practice in the UK. Midwifery 38: 14-20.    

49. Lee AS, M. K (2008) Disciplinary discourses: rates of cesarean section explained by medicine, midwifery, and feminism. . Health Care Women Int 29: 448-467.    

50. Tully KP, HL. B (2013) Misrecognition of need: women's experiences of and explanations for undergoing cesarean delivery. Soc Sci Med 85: 103-111.    

51. Coxon K SJ, Fulop N. T (2014) What Extent Are Women Free to Choose Where to Give Birth? How discourses of risk, blame and responsibility influence birth place decisions. Health Risk Soc 16: 51-67.

52. Latham SR, Norwitz ER. Ethics and "cesarean delivery on maternal demand"; 2009. Elsevier, 405-409.

53. Bryant J, Porter M, Tracy SK, et al. (2007) Caesarean birth: Consumption, safety, order, and good mothering. Soc Sci Med 65: 1192-1201.    

54. Possamai-Inesedy A (2006) Confining risk: Choice and responsibility in childbirth in a risk society. Health Sociol Rev 15: 406-414.    

55. Davis-Floyd RE (2004) Birth as an American rite of passage: With a new preface: Univ of California Press.

56. Nilsen ABV, WaldenstrÖM U, Hjelmsted A, et al. (2012) Characteristics of women who are pregnant with their first baby at an advanced age. Acta Obstet Gynecol Scand 91: 353-362.    

57. Aasheim V, Waldenström U, Hjelmstedt A, et al. (2012) Associations between advanced maternal age and psychological distress in primiparous women, from early pregnancy to 18 months postpartum. BJOG: Int J Obstet Gynaecol 119: 1108-1116.    

58. Mitchell LM (2001) Baby's first picture: Ultrasound and the politics of fetal subjects: University of Toronto Press.

59. Craven C (2005) Claiming respectable American motherhood: Homebirth mothers, medical officials, and the state. Med Anthropol Q 19: 194-215.    

60. Benoit C, Zadoroznyj M, Hallgrimsdottir H, et al. (2010) Medical dominance and neoliberalisation in maternal care provision: The evidence from Canada and Australia. Soc Sci Med 71: 475-481.    

61. Plested M, Kirkham M (2016) Risk and fear in the lived experience of birth without a midwife. Midwifery 38: 29-34.    

62. Rabinow P (1984) The Foucault Reader. New York: Pantheon Books.

63. Westfall R, Benoit C (2008) Interpreting compliance and resistance to medical dominance in women's accounts of their pregnancies. Sociol Res Online 13: 4.

64. Dahlen HG, Homer CS (2013) 'Motherbirth or childbirth'? A prospective analysis of vaginal birth after caesarean blogs. Midwifery 29: 167-173.

65. Rothman BK (2014) Pregnancy, birth and risk: an introduction. Health Risk Soc 16: 1-6.    

66. Crowe M, Carlyle D (2003) Deconstructing risk assessment and management in mental health nursing. J Adv Nurs 43: 19-27.    

67. Benoit C, Ouellet N, Jansson M (2016) Unmet health care needs among sex workers in five census metropolitan areas of canada. Can J Public Health 107: 266-271.    

68. Benoit C, Jansson M, Jansenberger M, et al. (2013) Disability stigmatization as a barrier to employment equity for legally-blind Canadians. Disabil Soc 28: 970-983.    

69. Stengel C (2014) The risk of being 'too honest': drug use, stigma and pregnancy. Health Risk Soc 16: 36-50.    

70. Benoit C, Magnus S, Phillips R, et al. (2015) Complicating the dominant morality discourse: mothers and fathers' constructions of substance use during pregnancy and early parenthood. Int J Equity Health 14: 72.    

71. Scamell M (2014) Childbirth Within the Risk Society. Sociol Compass 8: 917-928.    

Copyright Info: © 2017, Helga Hallgrimsdottir, et al., licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution Licese (http://creativecommons.org/licenses/by/4.0)

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