Date of Award

January 2012

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Jeannette Ickovics

Second Advisor

Stephen Latham

Abstract

One in three pregnant women delivering in the United States will undergo a cesarean section, at a rate of 32.8% and climbing. The cesarean section is associated with considerable excess risk of morbidity and mortality to infant and mother, including a four-fold risk of maternal death relative to vaginal birth. As the gatekeepers of surgical birth, obstetricians have an ethical and scientific imperative to minimize the number of non-indicated cesarean births. And yet, cesarean rates are responsive to fear of malpractice litigation, physician time-constraints, and patient payer-type. These findings, while ethically troublesome, point to a promising new direction for controlling the rising cesarean rate: looking to the subjective decision making processes preceding the cesarean decision. The purpose of this paper is to utilize the concept of moral luck to highlight the potential logical and ethical fallacies of the decision-making processes leading to cesarean delivery. Incentives to trade unknown risk for known risk compromise maternal and infant health--interventions occur even when substantial evidence suggests "doing nothing" increases likelihood of healthy vaginal birth. Protecting a non-interventionist model of birth is critical towards the public health goal of reducing the cesarean rate and improving maternal and infant outcomes.

Comments

This is an Open Access Thesis.

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