A Summer of Learning

When I first thought to write an honors thesis for my Health and Societies major, I didn’t know what to expect. The idea of leading my own research and crafting my own interviews felt daunting, to say the least. A few months later, as I am nearing the end of my research phase, I look back feeling thankful for the difficult, yet rewarding process.

This summer, I conducted a qualitative research study on the rising rates of C-sections in Telangana, India. When I embarked on this project, it was a bigger scale endeavor, consisting of ethnographic fieldwork, patient interviews, and hospital observations. While my research question remains the same at its core, many of these plans didn’t quite pan out to be as I had imagined. With the dramatic takeover of COVID-19, my plans for researching on the ground in India were immediately scrapped. Due to the ethical implications, I decided to change my interview scope to providers only, leaving out the essential patient perspective. Most importantly, I was not able to see the workings of a maternity clinic and the intimate interactions between providers, patients, and families during the decision-making processes of childbirth. 

However, I was able to get a deeper look into the opinions and perspectives of providers. When I began doing a literature review for this research, providers were cited to be the root of this entire problem of high C-section rates. Many were listing economic incentives and higher C-section payments to be the driving force behind providers recommending to perform C-sections on most mothers. However, many of these interviews revealed sociocultural factors that are embedded in society, well beyond the purview of the provider.

Factors of access to pain management, legal violence against providers, and the role of social class in healthcare decisions were some deeper structural concepts that were emphasized in many of these provider interviews. One interview with an OB/GYN who had been practicing for 30 years illustrated the crucial changes that have been shifting the nature of childbirth from a natural process to a medically induced, technical surgery. Many patients are also now associating these more medicalized births aided by C-section surgery to be more safe and predictable than vaginal birth. In addition, many providers claim pain tolerance to also be a changing idea amongst new mothers. With the more sedentary lifestyles of today, many mothers are unprepared for the pain that is associated with childbirth. Moreover, pain management and access to epidurals or other medications during childbirth is a very stigmatized topic in Indian healthcare. Beyond this, the legal violence against doctors with any bad outcomes, regardless of the doctor’s specific role in the outcome, is skyrocketing, especially in private healthcare settings, where the reputation of the hospital is everything to a doctor’s career. In such sensitive scenarios, the decision to perform a C-section delivery is oftentimes the safest decision for the doctor, as well.

These are just a few of the myriad of social reasons that back the decision to perform a C-section. Much more research is needed, especially from the patient side to determine how sources of maternal knowledge construct C-sections to be a safer method of delivery. 

Throughout this summer, I’ve learned to interview, craft questions, translate conversations, analyze interviews, and pull out large themes. As I begin to write this thesis, the overwhelming feeling returns, but hopefully as I read over this again at the start of 2021, many of the ideas above will be written into the paper for everyone to read.

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About Neelu Paleti

Neelu is a rising senior from Dublin, Ohio, studying Health and Societies at Penn. Her research interests lie in maternal and child health policies, as well as the institutionalization of medicine in India. Her senior thesis research revolves around the construction of power, choice, and safety in caesarean deliveries in South India. This research will explore how broader themes of decision-making and patient-provider dynamics affect the rising rates of C-sections in regions of India.