Structural and Individual Predictors of Variation in Cesarean Incisions

剖腹产率的上升促使了重大研究，以了解推动剖腹产率上升的因素以及母亲和新生儿的相关后果。对切开技术的关注较少，这些技术是可变的，可能与医院大小等结构性因素以及围绕分娩的个人因素和环境有关。这项研究使用医学和认知人类学的理论和方法来测试结构因素和个体因素在实施剖腹产手术中的相对重要性，回答了关于在受限的医疗环境和其他环境下决策的本质的基本问题。该项目培训一名人类学研究生以及来自代表性不足群体的本科生进行数据收集和分析，并涉及与护理提供者的合作。这项研究的结果将广泛传播给学术界和非学术界的受众以及不同的利益攸关方。研究人员在不同的医院环境中进行人种学研究，以获得对如何、为什么以及何时使用不同的剖腹产手术的广泛了解。两个相互关联的假设指导本研究：(1)在资源匮乏的医院工作的医生会进行更多的垂直切开；(2)患者的身体特征和社会背景将与切开类型相关。该项目使用对医院数据的分析，以及访谈、观察和认知人类学的方法和分析来检验这些假设。通过这样做，它实现了决策的动态性质，并有可能转变产科护理和生殖决策的学术知识。该奖项反映了NSF的法定使命，并通过使用基金会的智力优势和更广泛的影响审查标准进行评估，被认为值得支持。

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.