Structural and Individual Predictors of Variation in Cesarean Incisions

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The rise in cesarean rates has prompted significant research to understand the factors driving this increase as well as associated outcomes for mothers and neonates. Less attention has been paid to incision techniques, which are variable and likely correlated with structural factors such as hospital size, as well as individual factors and circumstances surrounding birth. This research uses medical and cognitive anthropological theories and methods to test the relative importance of structural versus individual factors in performing cesarean incision techniques, answering fundamental questions about the nature of decision-making in constrained medical settings and beyond. The project trains an anthropology graduate student as well as undergraduate students from underrepresented groups in data collection and analysis and involves collaborations with care providers. Results from this research will be disseminated widely to academic and non-academic audiences and to diverse stakeholders. The researchers conduct ethnographic research in diverse hospital settings to gain a broad understanding of how, why, and when different cesarean incisions are used. Two interrelated hypotheses guide this research: (1) doctors working in hospitals in resource-poor settings will perform more vertical incisions, and (2) patients’ physical characteristics and social backgrounds will be associated with incision type. The project uses analysis of hospital data, as well as interviews, observation, and cognitive anthropology methods and analysis to test these hypotheses. In doing so, it operationalizes the dynamic nature of decision-making and has the potential to transform academic knowledge of obstetric care and reproductive decision-making.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.