The Vanishing Mother: Cesarean Section and “Evidence‐Based Obstetrics”

Wendland, Claire

doi:10.1525/maq.2007.21.2.218

Cited by 73 publications

(73 citation statements)

References 37 publications

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“…Other women fi nd the unpredictability of a vaginal birth and the risks of instrumental vaginal deliveries and emergency CS unacceptable. An elective CS seems to magically ward off the unpredictability and danger of birth [113] .…”

Section: The Changing Attitude Of Women To Csmentioning

confidence: 99%

To ‘C’ or not to ‘C’?/Caesarean delivery upon maternal request: a review of facts, figures and guidelines

D’Souza

Arulkumaran

2012

Journal of Perinatal Medicine

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The last few decades have seen an unrelenting rise in caesarean section (CS) rates. In addition to an increase in numbers of CS performed worldwide, there has also been a change in the indications for CS, a reflection of changing times. A new dilemma facing obstetricians is the increasing demand for CS in the absence of any medical indication (caesarean delivery on maternal request - CDMR). The paucity of evidence either in favour or against, the poor understanding of long-term health and financial implications and the complex ethical issues surrounding CDMR make counselling extremely challenging. Needless to say, CDMR has generated enormous interest both in the media and among health-care providers, and many national and international bodies have now issued guidelines on the topic. In this editorial, we have aimed to explore the factors responsible for the increase in CDMR rates, assess the safety and cost implications of CS and review the recent guidelines and recommendations on CDMR.

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Section: The Changing Attitude Of Women To Csmentioning

confidence: 99%

To ‘C’ or not to ‘C’?/Caesarean delivery upon maternal request: a review of facts, figures and guidelines

D’Souza

Arulkumaran

2012

Journal of Perinatal Medicine

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“…We are not alone. The creation of EBM in the realm of obstetrics has increasingly come under fire from health care practitioners (see Downe, 2010;Enkin et al, 2006;Wendland, 2007). Strikingly, two of the original authors of the landmark text, A Guide to Effective Care in Pregnancy and Childbirth (Enkin et al, 1989), have since reflected upon their hand in the creation of an EBM movement that is blind to other types of knowledge (see Enkin et al, 2006;Keirse, 2011).…”

Section: Concluding Thoughts: Better 'Evidence' = Better Babies?mentioning

confidence: 99%

Ills from the womb? A critical examination of clinical guidelines for obesity in pregnancy

Jetté

Rail

2012

Health (London)

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In this article, we critically examine the clinical guidelines for obesity in pregnancy put forth by the Society of Obstetricians and Gynaecologists of Canada (SOGC) that are underpinned by the rules of Evidence-Based Medicine (EBM), a system of ranking knowledge that promises to provide unbiased evidence about the effectiveness of treatments. While the SOGC guidelines are intended to direct health practitioners on 'best practice' as they address pregnancy weight gain with clients in the clinical context, we question their usefulness, arguing that despite their commitment to objectivity, they remain mired in cultural biases that stigmatize large female bodies and associates them to 'unfit' mothers.

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“…Instead of isolated and individual decision-making, attention is increasingly centered on childbirth influences within culturally constructed knowledge (Béhague, 2002; Bryant et al, 2007; Munro et al, 2009; Wendland, 2007; Wittmann-Price et al, 2009), especially about the ‘ease’ and safety of cesarean section versus vaginal delivery (Gamble et al, 2007; Walker al., 2004; Weaver et al, 2007). ‘Preference’ for cesarean section is predicted by maternal beliefs about childbirth, including the degree of confidence they have in realizing vaginal delivery (Stoll et al, 2009) and whether they consider birth as a natural event (Haines et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Misrecognition of need: Women's experiences of and explanations for undergoing cesarean delivery

Tully

Ball

2013

Social Science & Medicine

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International rates of operative delivery are consistently higher than the World Health Organization determined is appropriate. This suggests that factors other than clinical indications contribute to cesarean section. Data presented here are from interviews with 115 mothers on the postnatal ward of a hospital in Northeast England during February 2006 to March 2009 after the women underwent either unscheduled or scheduled cesarean childbirth. Using thematic content analysis, we found women’s accounts of their experiences largely portrayed cesarean section as everything that they had wanted to avoid, but necessary given their situations. Contrary to popular suggestion, the data did not indicate impersonalized medical practice, or that cesareans were being performed ‘on request.’ The categorization of cesareans into ‘emergency’ and ‘elective’ did not reflect maternal experiences. Rather, many unscheduled cesareans were conducted without indications of fetal distress and most scheduled cesareans were not booked because of ‘choice.’ The authoritative knowledge that influenced maternal perceptions of the need to undergo operative delivery included moving forward from ‘prolonged’ labor and scheduling cesarean as a prophylactic to avoid anticipated psychological or physical harm. In spontaneously defending themselves against stigma from the ‘too posh to push’ label that is currently common in the media, women portrayed debate on the appropriateness of cesarean childbirth as a social critique instead of a health issue. The findings suggest the ‘need’ for some cesareans is due to misrecognition of indications by all involved. The factors underlying many cesareans may actually be modifiable, but informed choice and healthful outcomes are impeded by lack of awareness regarding the benefits of labor on the fetal transition to extrauterine life, the maternal desire for predictability in their parturition and recovery experiences, and possibly lack of sufficient experience for providers in a variety of vaginal delivery scenarios (non-progressive labor, breech presentation, and/or after previous cesarean).

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The Vanishing Mother: Cesarean Section and “Evidence‐Based Obstetrics”

Cited by 73 publications

References 37 publications

To ‘C’ or not to ‘C’?/Caesarean delivery upon maternal request: a review of facts, figures and guidelines

To ‘C’ or not to ‘C’?/Caesarean delivery upon maternal request: a review of facts, figures and guidelines

Ills from the womb? A critical examination of clinical guidelines for obesity in pregnancy

Misrecognition of need: Women's experiences of and explanations for undergoing cesarean delivery

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