Cesarean Section: An American History of Risk, Technology, and Consequence

Why have cesarean sections become so commonplace in the United States?

Between 1965 and 1987, the cesarean section rate in the United States rose precipitously--from 4.5 percent to 25 percent of births. By 2009, one in three births was by cesarean, a far higher number than the 5-10% rate that the World Health Organization suggests is optimal. While physicians largely avoided cesareans through the mid-twentieth century, by the early twenty-first century, cesarean section was the most commonly performed surgery in the country. Although the procedure can be lifesaving, how--and why--did it become so ubiquitous?

Cesarean Section is the first book to chronicle this history. In exploring the creation of the complex social, cultural, economic, and medical factors leading to the surgery’s increase, Jacqueline H. Wolf describes obstetricians’ reliance on assorted medical technologies that weakened the skills they had traditionally employed to foster vaginal birth. She also reflects on an unsettling malpractice climate--prompted in part by a raft of dubious diagnoses--that helped to legitimize ＂defensive medicine,＂ and a health care system that ensured cesarean birth would be more lucrative than vaginal birth. In exaggerating the risks of vaginal birth, doctors and patients alike came to view cesareans as normal and, increasingly, as essential. Sweeping change in women’s lives beginning in the 1970s cemented this markedly different approach to childbirth.

Wolf examines the public health effects of a high cesarean rate and explains how the language of reproductive choice has been used to discourage debate about cesareans and the risks associated with the surgery. Drawing on data from nineteenth- and early twentieth-century obstetric logs to better represent the experience of cesarean surgery for women of all classes and races, as well as interviews with obstetricians who have performed cesareans and women who have given birth by cesarean, Cesarean Section is the definitive history of the use of this surgical procedure and its effects on women’s and children’s health in the United States.

Jacqueline H. Wolf is a professor of the history of medicine at Ohio University. The author of Don’t Kill Your Baby: Public Health and the Decline of Breastfeeding in the 19th and 20th Centuries and Deliver Me from Pain: Anesthesia and Birth in America, she is the host and executive producer of the podcast Lifespan: Stories of Illness, Accident, and Recovery.