Why celebs think Caesars rule

Today it's estimated that a quarter of all births in London are Caesareans and an astonishing onethird of those are elective. It's a far cry from 20 or so years ago when only the most complicated pregnancies were allowed to culminate in an operation.

But now it seems that the celebrity trend for Caesarean births (everyone from Victoria Beckham to Zoe Ball has opted for the knife) has become one of the principal reasons for the huge public demand. "The research hasn't been done, but I'm certain the main reason for more women asking for Caesarean sections (CS) is celebrity influence," says Belinda Phipps, chief executive officer of the National Childbirth Trust. "In the past couple of years we've been barraged with stories of the rich and famous having CS by choice and we assume that, because they have the most expensive medical care, CS must be the best option. But just because someone is wellknown and well-off doesn't mean they have access to the best knowledge about birth. Where there are no sound medical reasons for a CS, it's a more risky option for both mother and baby."

The recently published National Sentinel Caesarean Section Audit Report (NSCSAR) reveals that 75 per cent of UK obstetricians share her view. "It's definitely not just the posh who won't push any more," says Dr Peter Bowen-Simpkins, spokesman for the Royal College of Obstetricians and Gynaecologists' charity for mothers, WellBeing. "All sorts of women now want CS."

The CS gets its name from the Roman emperor Julius Caesar who, it's believed, was delivered that way. It's a 30-minute operation involving a surgical incision through the abdominal and uterine walls. The woman can have a general anaesthetic, but is usually given an epidural (a injection of anaesthetic into the back, which numbs the lower part of the body).

Its supposed big advantage is convenience (you can book a date and time to give birth and spend half an hour doing it). However, although the timing of a vaginal birth is unpredictable, women are usually up and about within an hour of giving birth. CS is a little different, according to Gedis Grudzinskas, fertility specialist at the Bridge Centre and Professor of Obstetrics and Gynaecology at St Bartholomew's Hospital. "A CS is a major operation, so you can't expect to leap out of bed immediately. You won't be able to walk easily for at least 24 hours and after that you'll have a painful tummy for a week to a few months. Everyone heals differently, so no one can possibly give a recovery time for CS."

Women also opt for CS in the belief that it won't ruin their sex life by scarring their vaginal region, reducing clitoral sensitivity or stretching your vagina, as a vaginal birth can. But, says Grudzinskas, that's misleading. "Only 30 per cent of vaginal births require a definitive cut into the vagina to reduce the risk of serious tearing and most of those wounds heal without scarring. Some people are misinformed to such an extent that there's a feeling that the manner of giving birth shouldn't be chosen. Birth is not an excuse for major surgery. A CS is an invasive procedure that has major complications and far more risks than vaginal birth. You need a strong anaesthetic, for one, and that could go wrong. Yes, it's usually safe and yes, women usually recover perfectly well, but is nature so inefficient that we need to embark on an operation to give birth? No. Vaginal birth is better for both mother and child."

According to Phipps, women often have surgery if they don't have the right support at birth. "The UK has a huge problem in the lack of midwives. A good midwife will encourage a woman to keep moving in labour, to remain as upright as possible for the birth and to feel happy in her surroundings. If they don't and try to give birth on their backs, as they see on TV, the birth takes longer and it's painful. Those factors lead to an unpleasant birth, which could make women seek CS next time around, or could egg them on to ask the obstetrician for a CS during the first birth." If that happens, says Grudzinskas, most consultants will oblige. "If we say no and there's a problem with the birth, the woman might feel obliged to sue us. On top of that, doctors may be paid more for doing a CS."

? For further information on childbirth, call the National Childbirth Trust on 0870 444 8707 or go to www.nctpregnancyand babycare.com, or call WellBeing, the charity for mothers on 020 7772 6400 or go to www.wellbeing.org.uk