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• W1639730072 abstract "I have been invited to respond to two reviews of my book Cut it Out: The C-Section Epidemic in America and I will do so in turn. Ilana Löwy begins her review of the book with a largely on-target summary of the book's main points. Löwy then raises two critiques. The first is that pain medication is discussed in the book as something that is undesirable and leads to problems. I disagree with that framing of my discussion. I do not use the word ‘undesirable’ in my writing about pain medication, nor do I mean to imply this. What I do is review the evidence that epidurals may lead to Pitocin augmentation, which starts the woman on a trail of interventions. This may make a C-section more likely, especially for foetal distress. Nowhere in the book do I argue that pain medication should be withheld from women. In fact, being denied pain medication is unlikely to be a problem in the USA, where the vast majority of women receive analgesic pain relief. In the sample of post-partum women I studied, no woman was denied pain medication. However, some women did experience pressure to have an epidural. This finding is supported by the “Listening to Mothers III” survey, in which 15 per cent of women reported experiencing pressure to receive an epidural rather than being denied pain medication (Declercq et al. 2013). Löwy's second critique is of my focus on the USA. There is, of course, a strong tradition of researchers’ focusing on reproductive processes in the USA. I agree with Löwy that a comparative study of C-section practices would be intriguing, although, of course, cross-national data on birth is difficult to obtain and an interview or observational study like mine is already time-consuming and funding-intensive in just one country. Although it is clearly beyond the focus of my book, which intentionally focuses on the USA, such a study would be very valuable, especially in light of the US's poor performance on the Mother's Index, which ranks it 33rd and last among industrialised nations. Clearly, we are doing something wrong! the danger which is always present for the field of medical sociology is that our training does not particularly give us the skills to measure the efficacy of medical interventions, or to identify any potential complications from alternative treatments (such as the ones Morris suggests). She also adds that ‘it is beyond the scope of this study and [Morris’] expertise (as a sociologist, rather than a medical practitioner) to provide healthcare recommendations to women’. In truth, critically examining current medical care delivery and exposing how it is related to norms and structures of society is the heart and soul of medical sociology. It is unclear why sociologists, as trained research scientists, would be unable to critically read and assess medical literature and should rather cede that responsibility to clinicians, or how a journal like Sociology of Health & Illness would make a go of it without such a perspective. One of my main concerns with the review, though, is that Neller herself makes certain claims without giving significant evidence for them. For example, Neller dismisses my suggestion that low-risk women should consider giving birth in a birth centre or home, writing that ‘this logic introduces a plethora of potential health complications’. She writes off homebirth with one sentence, paying no attention to the huge amount of scholarship on this topic. In fact, there is much recent research that suggests that homebirth is as safe as hospital birth for low-risk women (for example, Halfdansdottir et al. 2015). Further, the UK National Health Service officially recommends that healthy, low-risk women should consider giving birth at home or in a birth centre because doing so is safer than giving birth in a hospital. Neller also calls into question my suggestion to reform the system for medical injury compensation to an outcomes-based model that compensates all birth injuries separate from investigating malpractice. Neller suggests that such a reform might cost too much. However, many law and health policy scholars discuss outcomes-based or administrative models as an alternative to the present US system for dealing with medical injuries (for example, Bovjberg 2006). Research shows the USA currently spends the most of any industrialised country on birth with some of the worst results, and that a ‘no fault’ system of medical injury compensation may well be quite affordable (Studdert et al., 1997). Finally, Neller refers to my book as ‘polemical’. It is true that, having completed this research and seen the effects of the C-section epidemic, I feel strongly about this issue. I am not alone in my misgivings. Other very ‘mainstream’ groups (including those made up of medical professionals) are also concerned about the high US C-section rate; for example, the American College of Obstetricians and Gynecologists, the Society for Maternal-Fetal Medicine, and the World Health Organization. Like me, they see the negative results of a high C-section rate on the heath and lives of women. There is no doubt that anything having to do with women's bodies (and especially mothers’ bodies) is political. What I do in Cut It Out is to provide an important lens through which to see the ways that organisations contribute to practices – typically conceptualised as the choices of individual clinicians and women – and strive to promote evidence-based change." @default.
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• W1639730072 date "2015-07-01" @default.
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• W1639730072 title "Morris, T. Cut it Out: The C-Section Epidemic in America. New York: New York University Press. 2013. 256pp £18.99 (hbk) ISBN 978-0-8147-6411-4" @default.
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