Childbirth and social class: the case of cesarean delivery.

The purpose of this paper is to examine how obstetrical intervention in childbirth varies according to the socioeconomic status of the birthing woman and what kinds of factors might account for the differences in treatment. We have focused specifically on the contemporary use of cesarean delivery to illustrate how one intervention is applied differently to women of different social classes. If cesarean deliveries were being done for medical reasons alone, we would see any variation in the rates explained by medical risk, and the highest rates among high risk women. Instead we found that more cesareans are being performed in the socioeconomic group of women with the lowest medical risk and much of the variation in cesarean rates explained by factors other than medical need. We focus mainly on characteristics associated with social class differences, and use historical and contemporary data to describe differences in cesarean delivery rates by social class, and to offer explanations for these differences. In addition we introduce some new New York City data to examine more closely cesarean delivery rates in two classes of birthing women and to explore the differential effects of new childbirth technology on women of different socioeconomic classes.