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Book part
Publication date: 22 November 2019

Kellie Owens

As maternal mortality increases in the United States, birth providers and policymakers are seeking new solutions to address what scholars have called the “C-section epidemic.”…

Abstract

As maternal mortality increases in the United States, birth providers and policymakers are seeking new solutions to address what scholars have called the “C-section epidemic.” Hospital cesarean rates vary tremendously, from 7 to 70 percent of all births. Based on in-depth, semi-structured interviews with 47 obstetricians and family physicians in the United States, I explore one reason for this variation: differences in how physicians perceive and manage risk in American obstetrics. While the dominant model of risk management encourages high levels of intervention and monitoring, I argue that a significant portion of physicians are concerned about high intervention rates in childbirth and are working to reduce cesarean rates and/or the use of monitoring technologies like continuous fetal heart rate monitors. Unlike prior theories of biomedicalization, which suggest that health risks are managed through increased monitoring and intervention, I find that many physicians are resisting this model of risk management by ordering fewer interventions and collecting less information about their patients. These providers acknowledge that interventions designed to mitigate risks may only provide an illusion of control, rather than an actual mastery of risks. By limiting interventions, providers may lose this illusion of control but also mitigate the iatrogenic effects of intervention and continuous monitoring. This alternative approach to risk management is growing in many medical fields and deserves more attention from medical sociologists.

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Reproduction, Health, and Medicine
Type: Book
ISBN: 978-1-78756-172-4

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Book part
Publication date: 24 October 2019

Sandra C. Buttigieg, Emanuela-Anna Azzopardi and Vincent Cassar

Medical errors in obstetric departments are commonly reported and may involve both mother and neonate. The complexity of obstetric care, the interactions between various…

Abstract

Medical errors in obstetric departments are commonly reported and may involve both mother and neonate. The complexity of obstetric care, the interactions between various disciplines, and the inherent limitations of human performance make it critically important for these departments to provide patient-safe and friendly working environments that are open to learning and participative safety. Obstetric care involves stressful work, and health care professionals are prone to develop burnout, this being associated with unsafe practices and lower probability for reporting safety concerns. This study aims to test the mediating role of burnout in the relationship of patient-safe and friendly working environment with unsafe performance. The full population of professionals working in an obstetrics department in Malta was invited to participate in a cross-sectional study, with 73.6% (n = 184) of its members responding. The research tool was adapted from the Sexton et al.’s Safety Attitudes Questionnaire – Labor and Delivery version and surveyed participants on their working environment, burnout, and perceived unsafe performance. Analysis was done using Structural Equation Modeling. Results supported the relationship between the lack of a perceived patient-safe and friendly working environment and unsafe performance that is mediated by burnout. Creating a working environment that ensures patient safety practices, that allows communication, and is open to learning may protect employees from burnout. In so doing, they are more likely to perceive that they are practicing safely. This study contributes to patient safety literature by relating working environment, burnout, and perceived unsafe practice with the intention of raising awareness of health managers’ roles in ensuring optimal clinical working environment for health care employees.

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Structural Approaches to Address Issues in Patient Safety
Type: Book
ISBN: 978-1-83867-085-6

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Book part
Publication date: 20 October 2014

Lauren Nicholas

Twin to Twin Transfusion Syndrome (TTTS) is a well understood, yet under-recognized, placental disease affecting any given pregnancy at a rate of 1 in 1,000. There is no…

Abstract

Purpose

Twin to Twin Transfusion Syndrome (TTTS) is a well understood, yet under-recognized, placental disease affecting any given pregnancy at a rate of 1 in 1,000. There is no clustering of TTTS; instead the threat remains pathologically distinctive due to its pervasiveness. However, while incidence rates are random, survival rates are not. Despite compliant acceptance of “routine prenatal care,” sadly, there are many women who for currently unknown reasons are not receiving the advanced prenatal care needed to appropriately screen for, diagnosis and treat TTTS. And these women are paying the ultimate price for such obstetrical oversight.

Methodology

This study hypothesizes that differential care being given by primary obstetricians of TTTS patients is resulting in experienced inequalities. Utilizing social reproduction theory, and through ethnographic and quantitative analyses of primary data, this study seeks to divulge the complex social processes taking place (or failing to take place) within the world of American obstetrics, and begin to understand how they are affecting TTTS mortality and morbidity rates.

Findings

Findings illuminate a profound imbalance of power and influence amongst the following entities: American Congress of Obstetricians and Gynecologists and Society of Maternal Fetal Medicine; obstetrical training and practice; and levels of patient awareness and advocacy.

Value

This study argues that the current social relations being reproduced by these entities are perpetuating a climate that allows for disregard of proper TTTS management. Specifically, this study theoretically explores what social relations and subsequent (in)actions are being reproduced prior to TTTS diagnoses, and applies the effects of those observations.

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Family and Health: Evolving Needs, Responsibilities, and Experiences
Type: Book
ISBN: 978-1-78441-126-8

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Book part
Publication date: 30 May 2018

Paola Bertoli and Veronica Grembi

In healthcare, overuse and underuse of medical treatments represent equally dangerous deviations from an optimal use equilibrium and arouse concerns about possible implications…

Abstract

In healthcare, overuse and underuse of medical treatments represent equally dangerous deviations from an optimal use equilibrium and arouse concerns about possible implications for patients’ health, and for the healthcare system in terms of both costs and access to medical care. Medical liability plays a dominant role among the elements that can affect these deviations. Therefore, a remarkable economic literature studies how medical decisions are influenced by different levels of liability. In particular, identifying the relation between liability and treatments selection, as well as disentangling the effect of liability from other incentives that might be in place, is a task for sound empirical research. Several studies have already tried to tackle this issue, but much more needs to be done. In this chapter, we offer an overview of the state of the art in the study of the relation between liability and treatments selection. First, we reason on the theoretical mechanisms underpinning the relationship under investigation by presenting the main empirical predictions of the related literature. Second, we provide a comprehensive summary of the existing empirical evidence and its main weaknesses. Finally, we conclude by offering guidelines for further research.

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Health Econometrics
Type: Book
ISBN: 978-1-78714-541-2

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Book part
Publication date: 30 June 2004

Terri A Winnick

Language is a fundamental and yet extraordinarily powerful medium. Language is more than the primary feature distinguishing humans from other species. As our principle means of…

Abstract

Language is a fundamental and yet extraordinarily powerful medium. Language is more than the primary feature distinguishing humans from other species. As our principle means of communication, language links us to culture, and in so doing, shapes our perceptions and determines the way in which we think (Clark, Eschholz & Rosa, 1981; Thorne, Kramarae & Henley, 1983). Language is inseparable from social life. Through language, individuals learn cultural patterns and political and social values (Mueller, 1973). Language also reflects the prejudices of society, with assumptions about relative status, power or appropriate behavior often built into the words we use to talk about different groups of people. As Frank and Anshen (1983) note, ageism, racism, and most importantly for this discussion, sexism, are all perpetuated by our language, even among those who consciously reject those prejudices.

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Gendered Perspectives on Reproduction and Sexuality
Type: Book
ISBN: 978-0-76231-088-3

Book part
Publication date: 22 November 2019

Katherine M. Johnson, Richard M. Simon, Jessica L. Liddell and Sarah Kington

There has been substantial interest in US cesarean rates, which increased from 5% of deliveries in the 1970s to nearly one-third of births by the mid-2000s. Explanations typically…

Abstract

There has been substantial interest in US cesarean rates, which increased from 5% of deliveries in the 1970s to nearly one-third of births by the mid-2000s. Explanations typically emphasize individual risk factors (e.g., advanced maternal age, increased BMI, and greater desire for control over delivery) of women giving birth, or address institutional factors, such as the medicalization of childbirth and the culture of liability leading physicians to practice defensive medicine. We focus here on another non-medical explanation – childbirth education (CBE). CBE is an important, underexplored mechanism that can shape women’s expectations about labor and birth and potentially lead them to expect, or desire, a cesarean delivery as a normalized outcome. We analyze data from three waves (2002, 2006, 2013) of the Listening to Mothers national survey on US women’s childbearing experiences (n = 3,985). Using logistic regression analysis, we examined both mode of delivery (vaginal versus cesarean), and attitudes about future request for elective cesarean among both primiparous and multiparous women. Despite previous research suggesting that CBE increased the likelihood of vaginal delivery, we find that CBE attendance was not associated with likelihood of vaginal delivery among either primiparous or multiparous women. However, both primiparous and multiparous women who attended CBE classes were significantly more likely to say they would request a future, elective cesarean. Furthermore, these effects were in the opposite direction of effects for natural birth attitudes. Our findings suggest that contemporary CBE classes may be a form of “anticipatory socialization”, potentially priming women’s acceptance of medicalized childbirth.

Book part
Publication date: 22 November 2019

Cara Delay and Beth Sundstrom

This chapter examines symphysiotomy in twentieth-century Ireland as one example of a systematized obstetric violence that has characterized Ireland’s modern history. Expanding…

Abstract

This chapter examines symphysiotomy in twentieth-century Ireland as one example of a systematized obstetric violence that has characterized Ireland’s modern history. Expanding scholarly interpretations of state- and Church-inflicted abuse of women in the twentieth century, this analysis establishes the medical profession as a central actor alongside the twentieth-century state-Church coalition that regulated women’s reproductive lives and engaged in systematic repression. This chapter recognizes that Ireland’s history of reproductive abuse and coercion did not just involve contraception or abortion but also labor and birth experiences. In addition, it offers a more complete and complex interpretation of obstetric violence by highlighting the experiences of married women with wanted pregnancies; almost all research to date focuses on the experiences of unmarried pregnant women or unwanted pregnancies. This examination of symphysiotomy and obstetric violence in Ireland illuminates the ways in which religious, national, and medical power has been mapped on women’s reproductive bodies, particularly in the decades after independence in 1922. It also makes essential links between Ireland’s past and present, demonstrating that a careful analysis of the history of obstetric violence and the religious underpinnings of it are essential in understanding Ireland today. With this research, we also place symphysiotomy within the context of the global reproductive justice movement, asking how a reproductive justice framework – one that links reproductive rights with social justice – can help us interpret obstetric violence and address the wounds of Ireland’s past.

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Reproduction, Health, and Medicine
Type: Book
ISBN: 978-1-78756-172-4

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Open Access
Book part
Publication date: 5 September 2019

Kylie Baldwin

Abstract

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Egg Freezing, Fertility and Reproductive Choice
Type: Book
ISBN: 978-1-78756-483-1

Book part
Publication date: 2 August 2023

Catarina Barata, Vânia Simões and Francisca Soromenho

Obstetric violence is the mistreatment of women in the setting of obstetric care, which includes preconception, medically assisted reproduction, pregnancy, childbirth and…

Abstract

Obstetric violence is the mistreatment of women in the setting of obstetric care, which includes preconception, medically assisted reproduction, pregnancy, childbirth and postpartum. Obstetric violence follows and perpetuates the devaluation and subjugation of women in patriarchal societies, where socio-cultural conceptions contribute to a view of the female body as faulty and deviating from the male prototype. These shape the perception that female reproductive processes require technological corrections. The medicalisation of reproductive processes and the mechanisation of a normal life event, with the threat of death and other life-changing consequences, disempower women and objectify the body and its functions.

The entrance of women into the workforce and the specialised fields, feminising care professions, failed to shift this paradigm. Female health workers are trained in the procedures instituted by dominant patriarchal structures, expressing values encoded in the professional culture and the institutions where they work. As women conform to the models they are exposed to during their training, perpetuating corporate hierarchies and practices, they act as agents and perpetrators of obstetric violence. Thus, obstetric violence also constitutes a specific type of violence against women at the hands of other women.

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The Emerald International Handbook of Feminist Perspectives on Women’s Acts of Violence
Type: Book
ISBN: 978-1-80382-255-6

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Book part
Publication date: 30 November 2020

Hyangmi Kim

This study seeks to explore the underlying benefits and constraints of travel among pregnant women. This study deploys a series of in-depth interviews involving 12 participants…

Abstract

This study seeks to explore the underlying benefits and constraints of travel among pregnant women. This study deploys a series of in-depth interviews involving 12 participants. The findings show that emotional refreshment and health promotion are the two benefits of travel expressed by pregnant travelers, while physical discomfort is an unavoidable constraint of travel. To lessen the obstacle of the trip, according to the constraint identified, this study suggests that service providers actively look into the particular needs of pregnant travelers, such as comfortable restrooms. Lastly, it gives a suggestion for future studies on the issues in connection with the examination of pregnant women's travel experiences in each trimester.

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Advances in Hospitality and Leisure
Type: Book
ISBN: 978-1-83982-385-5

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