Surviving the Cesarean: An Analysis of the Clinical Decision Making Culture in Obstetrics & Gynecology

Abstract

Black women are at the nexus of two converging pandemics: COVID-19 and maternal mortality. This thesis explores how racism in the clinical decision making culture of obstetrics & gynecology affects the non-emergency C-section utilization in Tulsa, Oklahoma. Chapter I involves an analysis of the care process intervention, TeamBirth, created by Ariadne Labs to improve patient-clinician communication within the labor and delivery space. Chapter II interrogates the power dynamics of American biomedicine. Chapter III defines the cultural foundations of obstetrics & gynecology by providing an overview of its history rooted in slavery. Chapter IV critiques the Technological Model of Birth used in hospital settings. Though not all the birth complications and injustices endured by Black women are directly linked to C-sections, I focus on this procedure because it is a microcosm of how Black women are treated. The growing C-section rates reveal a great deal about America’s ‘profit over people’ healthcare system, devaluation of Black women, and prolific anti-Black stereotypes. Though it is a seemingly objective surgical procedure, there are distinct cultural processes that manifest. These cultural dynamics, enmeshed with racism and capitalism, contribute to the Black maternal mortality epidemic. Examining clinical decision making is critical because enculturated racial ideologies and myths are threats to Black women’s wellbeing during hospital-based birth.