Childbirth in a Technocratic Age: The Documentation of Women’s Ex ...

In contrast to the theoretically open pathways in low-risk childbirth, higher risk can constrain childbirth pathways in different ways depending on individual circumstances (I use the term higher risk to reflect the limited predictive value of many risk factors). Seven mothers (9%) described known risk factors in their pregnancies. One mother with a history of serious kidney problems saw her choice of caregivers and subsequent steps on the pathway restricted by a referral to her community’s single perinatologist; the same constraint applied to two other mothers, one with severely low amniotic fluid, the other with cervical problems. One mother had preexisting type II diabetes, and her obstetrician had forewarned her of a possible change from an anticipated spontaneous vaginal delivery pathway to induced labor or to planned cesarean. Of the 16 (21%) mothers whose status was considered too risky for labor (see the following section on delivery mode), three had an identified risk factor: Two were pregnant with twins, and one had a surgical scar that precluded safe natural labor. Thirteen mothers were restricting their delivery modes because of previous cesarean delivery in the absence of other risk factors (see chapters 6 and 7).

Expected Delivery Mode

Maternal status determined which of the two available contemporary delivery modes, vaginal or cesarean delivery, mothers might expect. Cesarean delivery can be either labored, occurring after a mother anticipating vaginal birth has labored for a time, or planned in advance of labor to avoid labor’s physical stress and risks. Mothers planning cesarean anticipate surgery well ahead of time and therefore do not expect any labor experience. Standard birth-certificate reporting procedures render the breakdown between labored and planned cesarean difficult to ascertain (MacDorman, Menacker, & Declercq, 2008); however, an estimated half of the total 32% of U.S. mothers delivering by cesarean were planned because of a previous cesarean (Sakala & Corry, 2008), and “repeat cesareans” constitute by far the largest percentage of planned cesarean cases (see chapter 6). Higher risk is not necessarily cause