Competing Narratives: Examining Obstetricians? Decision-Making Regarding Indications for Cesarean Sections and Abdominal Incisions

This article examines the decision-making process among obstetric residents in a public maternity hospital in Mexico where the percentage of cesareans and of classical vertical incisions (rather than the more common transverse incision) were both higher than those recommended by the World Health Organization or national standards. Data were collected in 2018 through free list methodology (listing items that fall within a particular cultural domain or category) and semi-structured interviews with senior obstetric residents. Analysis revealed two competing narratives at work that influenced decision-making regarding the use of cesareans and incision type: though participants emphasized the importance of clinical indications, their reported decisions seemed to rely more heavily on subjective and non-clinical factors. Factors such as patient "type" and perceived pressure from patients influenced obstetricians' decisions to perform cesareans. Decisions about performing incision-type seemed based on a combination of clinical factors, surgical abilities, and structural pressures. The data illustrate the nuanced and contradictory elements within medical decision-making ideas and behaviors.