Caesarean or vaginarean epidemics ? Techno-birth, risk and obstetric practice in Turkey

Abstract

Caesarean sections (C-sections) have become a substitute for vaginal birth in a number of developing and emerging economies. Often in these contexts, the promotion of caesarean delivery as a safe or even zero-risk and zero-pain alternative to vaginal birth continues to serve as a powerful discursive tool in governing childbirth, despite growing international evidence on the iatrogenic effects of C-sections. These caesarean ‘epidemics’ are often explained in terms of obstetricians’ individual preferences for C-sections. Drawing on ethnographic research conducted in one private and one public hospital in western Turkey, I argue that there are a wide range of factors influencing obstetricians’ risk conceptualisations, discourses and practices. I also contend that the medical justifications for C-sections and their public popularity can best be understood by looking at the ways in which both caesarean and vaginal births are organised. In the settings examined, the processes around caesarean and vaginal births were blurred to such an extent that vaginal delivery was, in its technicised and closely monitored nature, transformed into what I propose to call ‘vaginarean’ birth. Recent state regulations in Turkey aiming to prevent ‘caesarean abuse’ had only had limited effects on obstetricians’ practices. The notion of risk continued to operate as a major driving force in that an institutional risk colonisation came to compete with medical framings of risk, while deficiencies in the national obstetric care system were made invisible. I conclude that regulations aimed at eradicating a caesarean epidemic, such as those implemented in Turkey since 2012, are unlikely to be effective unless they also aim to combat the vaginarean epidemic.

Keywords:

• caesarean sections
• Turkey
• construction of risk
• institutional risk
• vaginarean birth
• public and private hospitals

Acknowledgements

The author thanks the two anonymous reviewers as well as Patrick Brown for their precious critiques, comments and suggestions on this paper. She also thanks all the persons who made this research possible by accepting to share with her their experiences during the field work.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1. For a similar discussion, see Mc Callum (2005).

2. Rothstein (2006) mainly deals with the former. He defines ‘risk colonisation’ as a configuration in which institutional risk has gradually occupied a central place in the definition of objects, methods and rationale of governance.

3. A counterexample to vaginarean birth would be ‘natural caesarean’ delivery (see Maffi, 2013). It should be noted that the health professionals and women who were the subjects of this field study never used the term ‘vaginarean’. A similar term has only been used once and that was in a journal article by a gynaecologist from Istanbul. See Özer, S., 2015, Vajeryen olacagina sezaryen olsun ! (‘Go for caesarean rather than vaginarean!’), HT Hayat (online newspaper), 9 November 2015.

4. Previous fertility rates were 2.73 per cent in 1993, 2.61 per cent in 1998, 2.22 per cent in 2003 and 2.15 per cent in 2008.

Additional information

Funding

This work was supported by the Agence Nationale de la Recherche (ANR Hypmedpro) [1]