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Cutting Women: Unnecessary cesareans as iatrogenesis and obstetric violence

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  • Smith-Oka, Vania

Abstract

This article deepens the current understanding of the sources of obstetric violence and iatrogenesis through an analysis of cesareans. The data are drawn from ethnographic research in 2018 at a public maternity hospital in Mexico. Data collection methods included observation, semi-structured interviews, and free lists with 12 senior obstetrics residents. Analysis of the data revealed that: (1) doctors used perceptions of high risk to justify their use of cesareans even when not clearly medically indicated; (2) doctors responded to scarcities of time and resources in the system by viewing cesareans as a less than ideal but acceptable solution; and (3) doctors practiced medicine defensively as a way to control their fear of risk and to pre-empt legal consequences from patients’ demands. The discussion suggests that the relative ease of cesareans and the benefit they provided the doctor and medical system rather than the patient constituted forms of obstetric violence and iatrogenesis. These often arise as a consequence of either too much intervention or not enough in situations in which providers seized on unclear or presumed indications as pretexts to perform cesareans that were not clearly medically indicated.

Suggested Citation

  • Smith-Oka, Vania, 2022. "Cutting Women: Unnecessary cesareans as iatrogenesis and obstetric violence," Social Science & Medicine, Elsevier, vol. 296(C).
    • Handle: RePEc:eee:socmed:v:296:y:2022:i:c:s0277953622000375
    DOI: 10.1016/j.socscimed.2022.114734
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    References listed on IDEAS

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    1. Smith-Oka, Vania, 2015. "Microaggressions and the reproduction of social inequalities in medical encounters in Mexico," Social Science & Medicine, Elsevier, vol. 143(C), pages 9-16.
    2. Bassett, Ken L. & Iyer, Nitya & Kazanjian, Arminee, 2000. "Defensive medicine during hospital obstetrical care: a by-product of the technological age," Social Science & Medicine, Elsevier, vol. 51(4), pages 523-537, August.
    3. Núria Homedes & Antonio Ugalde, 2009. "Twenty-Five Years of Convoluted Health Reforms in Mexico," PLOS Medicine, Public Library of Science, vol. 6(8), pages 1-8, August.
    4. Sakala, Carol, 1993. "Medically unnecessary cesarean section births: Introduction to a symposium," Social Science & Medicine, Elsevier, vol. 37(10), pages 1177-1198, November.
    5. Strong, Adrienne E., 2017. "Working in scarcity: Effects on social interactions and biomedical care in a Tanzanian hospital," Social Science & Medicine, Elsevier, vol. 187(C), pages 217-224.
    6. Tsang, Eric W. K., 2014. "Old and New," Management and Organization Review, Cambridge University Press, vol. 10(03), pages 390-390, November.
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