The experience of middle-class women during and after caesarean deliveries: Bangladesh context

Abstract

Drawing on twelve months of ethnographic fieldwork in Dhaka, Bangladesh, this thesis examines how biomedical authority shapes childbirth experiences among middle-class women. Caesarean delivery rates among urban, educated women reached 44% by 2022 despite limited medical necessity. Based on interviews with 30 women, 14 medical professionals, 5 pharmacy staff, and 3 government officials, along with participant observation at Square Hospital and Dhaka Medical College Hospital (DMCH), I show how women's seemingly autonomous choices are systematically channelled toward caesarean births. I develop the concept of the 'techno-normal' birth to describe how women redefine natural childbirth to include extensive technological interventions while still considering such deliveries normal. This reflects how middle-class identity is tied to private hospital births as symbols of modernity. Yet the very methods women pursue to secure vaginal birth through routine monitoring, labour induction with Pitocin, and epidurals- paradoxically elevate the likelihood of caesarean delivery. This paradox stems from profound support deficits during pregnancy, where the biomedical system dismisses women's embodied experiences through standardised responses and prioritises technological assessments over lived realities. The erosion of intergenerational knowledge further leaves women unprepared for labour, which they consequently interpret as pathological pain requiring intervention rather than physiological discomfort. Within this context, risk discourse functions as a powerful mechanism of control. Risks are constructed around a wide range of medical and social factors, such as breech presentation, low amniotic fluid, previous miscarriage or even holiday scheduling- all strategically deployed to justify surgical intervention. Many of the women during the interview reported encountering obstetric violence, including denial of information, punitive anaesthesia practices, dissipation of pain and newborns requiring intensive care unit admission despite surgical birth. Some of the women even experience lasting disabilities from anaesthesia complications, acknowledged yet minimised by clinicians as acceptable costs of motherhood. This thesis argues that while middle-class economic privilege grants access to biomedical care, it does not safeguard women from institutional violence or ensure better outcomes. Transforming this landscape requires three interconnected shifts, such as expanding doula services with state support; extending government oversight to monitor non-essential interventions and enforce accountability; and recognising home birth as safe for low-risk pregnancies by integrating midwives and traditional birth attendants into formal health care. Only such systematic change can create birth environments that genuinely respect women's autonomy and well-being beyond the profit-driven medicalisation that currently defines obstetric care in Bangladesh. Show more