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Elective Cesarean: Babies On Demand

C-Sections are on the rise and moms are getting blamed, but is it really the woman's fault?

WebMD Feature
Reviewed by Louise Chang, MD

One look at People Magazine or Entertainment Tonight, and you might think the old-fashioned labor and delivery way to birth a baby has gone the route of the horse and buggy.

In its place: The mother-requested cesarean, or C-section, delivery -- the fast, high-tech, hip celebrity way to have a child.

Or so, a popular theory goes.

"There's no doubt in my mind that the current interest in elective cesarean births has been ignited by the fact that in our in pop culture many celebrity deliveries have been elected cesareans," says Manuel Porto, MD, chairman of the department of obstetrics and gynecology at the University of California, Irvine.

Indeed, from media reports on the pregnancies of rock stars like Madonna, Victoria Beckham, and Britney Spears, to actresses like Gwyneth Paltrow, Kate Hudson, Patricia Heaton, and Elizabeth Hurley -- not to mention a gaggle of super models in between -- the C-section appears to be the "it" activity of the decade.

Despite health risks for both baby and mom -- including a life-threatening uterine rupture for women and a greater risk of stillbirth for baby -- C-section deliveries are rising. According to the National Institutes of Health, the current rate is 29.1% -- up some 40% between 1996 and 2004.

But who is really responsible for the rise? Not everyone is ready to blame the lady on the table.

Some suspect the guy wielding the scalpel. After all, the word "elective" simply means there is no medical justification -- it doesn't specify who made the request.

True, in celebrity-conscious New York City, some doctors say women are at least partly to blame.

"I have definitely seen an increase in C-section requests, even when there is no real medical justification behind it," says Ashley Roman, MD, a maternal fetal medicine specialist at NYU Medical Center in New York.

Her patients don't necessarily want to mimic celebrity life. They frequently cite other reasons -- particularly a reduced risk of incontinence and an easier, less painful birth, though she says medical literature is scant in support of either.

But organizations like Childbirth Connection argue this doesn't reflect the attitudes of women nationwide. Their surveys show less than 0.08% of pregnant women request a C-section.

"From our research we can say for sure that it is not mothers who are causing the elective C-section rate to rise," says Maureen Corry, executive director of ChildbirthConnection.org.

What Mothers Say

Indeed, when you look beyond the glitter of the Hollywood delivery and into the nurseries of working class America, a very different picture emerges.

"Some of the increase in elective cesareans is due to mother request, but I personally believe that group is a very small, very affluent subset of women and does not represent the desires or needs of most mothers," says Peter Bernstein, MD, MPH, a maternal-fetal medicine specialist at Montefiore Medical Center in the Bronx.

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