Cutting Women: Unnecessary cesareans as iatrogenesis and obstetric violence

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.