A Social History of Cesarean Section in the United States

美国剖腹产的社会史

• 批准号: 8015514
• 负责人: JACQUELINE H. WOLF
• 金额: $ 4.81万
• 依托单位: OHIO UNIVERSITY ATHENS
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-15 至 2014-09-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8015514
• 关键词: Abruptio Placentae; Attitude; Autobiography; Biography; Birth; Books; Case Study; Cesarean section; Charities; Child health care; Childbirth; Communities; Data; Discipline of obstetrics; Ensure; Event; Factor Analysis; Fetus; Foundations; Frequencies; Health; Health Insurance; Health Personnel; Home environment; Hospitals; Intervention; Interview; Journals; Letters; Life; Manuals; Medical; Medical Technology; Medicine; Mothers; Neonatal; Newspapers; Operative Surgical Procedures; Oral; Outcome; Paper; Perception; Performance; Physicians; Placenta; Population; Pregnancy; Principal Investigator; Procedures; Ptosis; Publishing; Recording of previous events; Risk; Rosa; Services; Shapes; Source; Textbooks; Time; United States; Vagina; Vaginal delivery procedure; Woman; Women Physicians; World Health Organization; Writing; diaries; evidence base; operation; social

DESCRIPTION (provided by applicant): Between 1965 and 1987 the cesarean section rate in the U.S. rose 455 percent, from 4.5 percent to 25 percent of births. While cesarean section was an appropriate and necessary procedure in a significant number of these births, the World Health Organization (WHO) has long estimated that the optimal cesarean section rate is between 5 and 10 percent of births and that a rate above 15 percent is apt to do more harm than good. Recent studies seem to corroborate WHO's assertion that the effects of a high cesarean section rate on a largely low-risk population are costly in both monetary and health terms. The proposed book will be the first in-depth social history of cesarean section in the 19th- and 20th- century U.S. and the first to examine the historical, cultural, and social issues, in addition to the medical factors, that have contributed to today's cesarean section rate of 32 percent. The book has four objectives: (1) To examine how the definition of "normal" labor and birth changed over the course of the nineteenth and twentieth centuries and to study the effect of that changing definition on lay and medical views of medical intervention during birth, particularly the performance of cesarean section. (2) To explore how standard obstetric treatment changed over this same period, particularly when medical personnel encountered a birth they deemed problematic. (3) To examine how the meaning of risk in relation to birth changed over time and to study how this change shaped medical and lay attitudes toward vaginal versus cesarean birth. (4) To study how historical, social, and cultural forces seemingly unrelated to health and medicine shape medical decisions and standard medical practices particularly in an arena such as birth, an event that represents so many societal hopes and concerns. In essence, this social history will examine the historical, social, cultural, and medical factors that shape standard obstetric practices, using cesarean section as a case study. As a historian of medicine, the P.I. will trace the social and cultural context of cesarean section over a roughly 200-year period from a time when the operation was among the most fatal of surgical procedures to the present day when the medical and lay communities view cesarean section as comparable and, at times, preferable to vaginal birth. Data for this book will be culled from oral history interviews with mothers and physicians and myriad archival and published sources including women's letters and diaries; physicians' personal papers; obstetric textbooks; articles in medical journals, newspapers, and magazines; doctors' casebooks; lying-in hospital casebooks; the papers of medical charities, home birthing services, lying-in hospitals, birth reform organizations, and medical and health insurance organizations; pregnancy and childbirth advice manuals; and physicians' and women's biographies and autobiographies.

描述(由申请人提供)： 1965至1987年间，美国的剖腹产率上升了455%，占新生儿的比例从4.5%上升到25%。虽然剖腹产在相当数量的新生儿中是一种适当且必要的手术，但世界卫生组织(WHO)长期以来一直估计，最佳剖腹产率在新生儿的5%至10%之间，超过15%的剖腹产率往往弊大于利。最近的研究似乎证实了世卫组织的断言，即高剖腹产率对主要是低风险人群的影响在金钱和健康方面都是代价高昂的。 这本拟议中的书将是19世纪和20世纪美国第一部关于剖腹产的深度社会史，也是第一本研究历史、文化和社会问题的书，除了医学因素外，这些问题也是导致今天32%的剖腹产率的原因。这本书有四个目标：(1)研究在19世纪和20世纪期间“正常”分娩和分娩的定义如何变化，并研究这种变化的定义对分娩期间医疗干预的一般和医学观点的影响，特别是剖腹产的表现。(2)探讨标准产科治疗在同一时期如何变化，特别是当医务人员遇到他们认为有问题的分娩时。(3)研究与分娩相关的风险的含义是如何随着时间的推移而变化的，并研究这种变化如何形成医学上对阴道分娩与剖腹产的态度。(4)研究看似与健康和医学无关的历史、社会和文化力量如何影响医疗决策和标准医疗实践，特别是在出生等领域，这一事件代表了如此多的社会希望和关切。 从本质上讲，这本社会史将以剖腹产为例，考察形成标准产科做法的历史、社会、文化和医学因素。作为一名医学史学家，私家侦探将在大约200年的时间里追踪剖腹产的社会和文化背景，从剖腹产是最致命的外科手术之一开始，到今天，医学界和非医学界认为剖腹产与阴道分娩类似，有时甚至更好。 这本书的数据将从对母亲和医生的口述历史采访和无数的档案和出版来源中精选出来，包括妇女的信件和日记；医生的个人文件；产科教科书；医学期刊、报纸和杂志上的文章；医生的案例书；住院分娩的案例书；医疗慈善机构、家庭分娩服务机构、产妇医院、生育改革组织和医疗和健康保险组织的文件；怀孕和分娩建议手册；以及医生和妇女的传记和自传。