Cesarean Section: An American History of Risk, Technology, and Consequence by Jacqueline H. Wolf

Reviewed by: Cesarean Section: An American History of Risk, Technology, and Consequence by Jacqueline H. Wolf Beth A. Robertson (bio) Cesarean Section: An American History of Risk, Technology, and Consequence By Jacqueline H. Wolf. Baltimore: John Hopkins University Press, 2018. Pp. 320. According to the World Health Organization (WHO), the number of women who give birth through cesarean section has grown rapidly, making up 1 in 5, or 21% of all births globally. Moreover, this number is predicted to increase, potentially rising to 29% by 2030 (Keenan, WHO website, June 2021). Cesarean section rates notably vary across countries and regions. In the United States for instance, cesarean births have risen even faster, from 23% in 2000, to 31.7% in 2019 (Martin, National Vital Statistics, 2019). Dr. Jacqueline H. Wolf skillfully examines this historical shift in her new book Cesarean Section that builds upon other work Wolf has authored, including Don't Kill Your Baby (Ohio State University Press, 2001) and Deliver Me from Pain (Johns Hopkins University Press, 2009). Wolf begins her narrative in 1800s America, where cesarean sections were essentially a death sentence for either the mother, child, or both. The intervention was consequently performed rarely and mostly on poor racialized women. The belief that black women were "hardier," and thus more likely to survive surgery, also inclined physicians to "experiment" in ways they would not with white women (p. 25). This grim context of death and racism nonetheless paved the way for evolving surgical practices that resulted in slightly less lethal medical interventions, especially when coupled with the introduction of anesthesia and acceptance of the germ theory of disease. Cesarean sections nevertheless remained rare until the first two decades of the twentieth century. Physicians' gradual willingness to perform cesarean sections resulted in greater attention to pregnancy and childbirth in medical training, as well as innovations such as low traverse cut and prenatal care. A changing, yet continuous context of racism also shaped the practice according to Wolf. By the 1940s, cesarean sections were increasingly presented as "safe," if not easier, childbirths in an effort to encourage upper class white women to have more children and thus prevent what was then deemed as "race suicide" (p. 74). In the face of the 1950s and 1960s baby boom, cesarean sections were also considered more efficient than natural birth, which appealed to medical staff working in hospitals suddenly overcrowded with pregnant women. A mounting focus on technology and surgery did lead to backlash in the form of the birth reform movement of the 1970s and 1980s when many pregnant people pushed for their right to opt out of unnecessary surgeries [End Page 552] or drugs. The daughters of 1980s birth reformers, however, found value in the ability to schedule their own pregnancy with more predictable results. This again led to a spike in cesarean sections in the United States, as well as globally, that remains prevalent today. Wolf charts the evolving trajectory of increased medical intervention and cesarean surgeries and the attitudes and practical elements that led to ebbs and flows over the nineteenth, twentieth, and early twenty-first century. Despite her thoroughness, some questions emerge that are never fully answered—the weightiest perhaps being why did and do physicians continue to turn to cesarean section? Although the lethality of such procedures has diminished, unnecessary cesarean surgeries can still have both short and long-term health consequences according to WHO and other global experts (Keenan, WHO website, June 2021; Sandall et al., Lancet, October 2018). Wolf could have drawn more from feminist theory to help answer this question and frame her detailed narrative, either the shifting views of women's bodies and pregnancy or the gendering of the medical profession that others like Carolyn Skinner (Women Physicians and Professional Ethos, 2014) and Wendy Mitchinson (Giving Birth in Canada, 2017) have examined in depth. Smaller questions also emerge regarding Wolf's methodology and approach. For instance, why did Wolf focus on Chicago and Ohio as her primary locations to collect oral histories, and how does this influence the viewpoints she presents? Although Wolf occasionally draws from the international context, she could also pay more attention to how global trends shaped cesarean...

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