Katherine M. Johnson, Richard M. Simon, Jessica L. Liddell, Sarah Kington

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


There has been substantial interest in US cesarean rates, which increased from 5% of deliveries in the 1970s to nearly one-third of births by the mid-2000s. Explanations typically emphasize individual risk factors (e.g., advanced maternal age, increased BMI, and greater desire for control over delivery) of women giving birth, or address institutional factors, such as the medicalization of childbirth and the culture of liability leading physicians to practice defensive medicine. We focus here on another non-medical explanation — childbirth education (CBE). CBE is an important, underexplored mechanism that can shape women's expectations about labor and birth and potentially lead them to expect, or desire, a cesarean delivery as a normalized outcome. We analyze data from three waves (2002, 2006, 2013) of the Listening to Mothers national survey on US women's childbearing experiences (n = 3,985). Using logistic regression analysis, we examined both mode of delivery (vaginal versus cesarean), and attitudes about future request for elective cesarean among both primiparous and multiparous women. Despite previous research suggesting that CBE increased the likelihood of vaginal delivery, we find that CBE attendance was not associated with likelihood of vaginal delivery among either primiparous or multiparous women. However, both primiparous and multiparous women who attended CBE classes were significantly more likely to say they would request a future, elective cesarean. Furthermore, these effects were in the opposite direction of effects for natural birth attitudes. Our findings suggest that contemporary CBE classes may be a form of “anticipatory socialization”, potentially priming women's acceptance of medicalized childbirth.

Original languageEnglish
Pages (from-to)241-260
Number of pages20
JournalAdvances in Medical Sociology
StatePublished - 2019


  • Anticipatory socialization
  • Birth outcomes
  • Cesarean delivery
  • Childbirth education
  • Medicalization
  • US childbirth


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