![\"Morris\"](\"http:\/\/commons.trincoll.edu\/reporter-winter2014\/files\/2014\/02\/Morris.jpg\")
<\/a>by Jim H. Smith<\/i><\/p>\nDuring a long flight in the summer of 2006, Trinity Professor of Sociology Theresa Morris struck up a conversation with the woman beside her. It only took introductions for Morris to discover they had something in common.<\/p>\n
A graduate of Texas A&M University, where she earned her M.S. degree in 1996 and her Ph.D. in 2000, Morris had just been awarded tenure after teaching at Trinity for six years. An expert on sociological issues related to banking and economic policy, she had produced a solid body of scholarship on subjects such as institutional racism in banking and the sociological implications of corporate reorganization.<\/p>\n
Now, tenured, she was poised to embark upon research into the increasing consolidation of the banking industry, a project that would occupy her for years. It was research for which she\u2019d spent nearly a decade laying the foundation, and it would have pretty much defined the balance of her career. The trouble was, Morris found herself increasingly ambivalent.<\/p>\n
Unexpectedly, she had developed an interest in something decidedly afield from banking and economics. It began as a personal inquiry but soon transcended that as she discerned much broader social implications. Now, every time she contemplated plunging into the banking project, the new subject gnawed at her.<\/p>\n
\u201cI was stuck,\u201d she says. \u201cI didn\u2019t know what to do.\u201d<\/p>\n
On that long flight it was a relief to talk about it with her fellow passenger. The other woman was a patient listener. A labor and delivery nurse, she found Morris\u2019s story compelling. It began with the birth of Morris\u2019s son, Benjamin, in 2000.<\/p>\n
A system out of balance<\/strong><\/p>\n Only at the hospital, after Morris had gone into labor, was it discovered that her baby had flipped in utero and was presenting in the bottom-down, or breech, position. This is how Morris learned that few doctors and hospitals are comfortable with vaginal delivery of breech babies.<\/p>\n Caesarean delivery\u2013commonly referred to as \u201cC-section\u201d\u2013presents decided risks for the mother. It is, after all, major surgery. There is a greater likelihood of medical complications, including infection and maternal death. Recovery time is also greater. And a C-section costs roughly twice as much as a vaginal birth.<\/p>\n Nevertheless, it is rationalized as an intervention that can protect the baby and minimize lifelong health problems such as cerebral palsy and neurological impairment. Both disorders may result from complicated deliveries, and they are among the most common foundations for malpractice lawsuits, even when the cause is unclear. The practice of obstetrics is so high risk, says Morris, that almost every obstetrician can expect to be sued at least once during his or her career. Consequently, malpractice insurance premiums can run to $100,000 a year or more.<\/p>\n Though disappointed by her own C-section, Morris was undaunted. When she became pregnant again two years later, she was all the more determined to deliver her second baby\u2013daughter Allison\u2013vaginally. \u201cOnce you\u2019ve had a C-section, you are automatically considered high risk,\u201d she notes, \u201cand you\u2019re treated in a different way by both doctors and nurses.\u201d Still, vaginal birth after C-section (VBAC in health care parlance) is not uncommon, although it may be difficult to find a doctor and a hospital that will support the decision to avoid Caesarean delivery.<\/p>\n Morris began planning early and reading anything she could get her hands on about VBAC. She learned about the arguments for and against VBAC, and she developed a careful delivery plan. The more she read, the more she became convinced that her Caesarean delivery might have been unnecessary. Moreover, she was soon convinced that she was hardly unique in that respect.<\/p>\n So, after the successful vaginal delivery of Allison, Morris kept researching the topic. \u201cI couldn\u2019t let it go,\u201d she says. \u201cEverything I read led to something else, and a picture began to emerge of a system out of balance, in which the most dangerous method of birth is widely encouraged, often required, for a host of reasons.\u201d<\/p>\n That\u2019s the story she told the nurse on the plane. \u201cShe suggested that I should follow what I was interested in,\u201d says Morris.<\/p>\n Culture of safety<\/strong><\/p>\n It was good counsel. That fall Morris began interviewing health care professionals and women who\u2019d had Caesarean sections. Over the next five years, she would interview nearly 150. Their stories and insights\u2013individually and collectively\u2013are one of the strengths of Morris\u2019s informative and highly readable new book, Cut It Out: The C-Section Epidemic in America<\/i>.<\/p>\n According to the Centers for Disease Control, the rate of C-sections in this country has increased by 26 percent in the past decade. Fully a third of all births in 2012 were by Caesarean. Even more astounding is what happens to women who\u2019ve undergone a C-section and then hope to deliver subsequent babies vaginally. Faced with the fact that a third of hospitals and half of doctors do not allow VBACs, 90 percent of all women who\u2019ve had a C-section will go that same route with subsequent pregnancies.<\/p>\n \u201cThe principal clinical reasons for C-sections are fetal distress, labor that goes on for too long, and babies that are too large,\u201d says Morris. \u201cHowever, there are many situations where the decision to use Caesarean may amount to excessive erring on the side of caution.\u201d<\/p>\n To illustrate the point, she explains the most surprising discovery she made while researching Cut It Out<\/i>. Many C-sections result from a disagreement between doctors and maternity nurses over Pitocin, a synthetic form of the hormone oxytocin, which is used to induce labor.<\/p>\n \u201cAn estimated 40 percent of women giving birth in the United States receive Pitocin,\u201d says Morris. \u201cThat may be excessive, and there\u2019s a culture of safety that argues against use of Pitocin. However, the problem that I discovered while doing my research is that many women receive epidural anesthesia to deal with pain during labor. Those women often need Pitocin to augment labor, and often they don\u2019t get enough. Since maternity nurses actually control Pitocin administration, doctors cannot give their patients more of the hormone than the nurses will allow.<\/p>\n \u201cI was shocked to find out that this is the most common area of disagreement between doctors and maternity nurses,\u201d she adds. \u201cWhen the nurses, adhering to protocol for Pitocin administration, won\u2019t give patients more of it, the next thing you know, the doctor orders a C-section.<\/p>\n There are, says Morris, a lot of untrue assumptions about Caesarean section. Perhaps the most prevalent is the widely held belief that greedy doctors cynically perform unnecessary C-sections to make more money. That\u2019s not generally the case, she says. Most doctors genuinely care about their patients, but they find themselves ensnared in a web of regulations, insurance requirements, and legal constraints in which they may be quick\u2013perhaps too quick\u2013to order C-sections.<\/p>\n \u201cI was sitting with a doctor at a local hospital one evening,\u201d she recalls. \u201cHe was on call. He said something like, \u2018Sometimes we\u2019re monitoring a woman who has been in labor for a while, and I\u2019m waiting to see how things will develop. I call my wife, and she tells me to just do the C-section. If something goes wrong, we could lose our house.\u2019 That\u2019s when it hit me that the link between C-sections and the fear of liability risk is not contrived.\u201d<\/p>\n The cause for the \u201cepidemic\u201d of C-sections, Morris says, is not simplistic. In Cut It Out<\/i> she uses her research findings to show that it is a procedure at the crossroads of many different influences\u2013legal, medical, and political. Together these influences have engendered the \u201cculture of safety\u201d in which a procedure with many inherent risks becomes the standard of practice all too often.<\/p>\n Most books that deal with C-section are guides, Morris says. \u201cMy book is not like that. I am an organizational sociologist, and I look for commonalities. Over the past six years, I\u2019ve discovered many of them. I know a lot of people care about this issue, and I think I have something important to share with them.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":" Professor Theresa Morris sheds light on America\u2019s extreme C-section rate by Jim H. Smith During a long flight in the summer of 2006, Trinity Professor of Sociology Theresa Morris struck up a conversation with the woman beside her. It only … Continue reading