When the media covers the rising rate of c-section, it’s often ready to lay the blame at the feet of a woman we’re come to know well over the last few years -- the busy career mom scheduling her delivery between important business deals. But while some moms may be requesting surgical birth, research shows that has little to do with the overall increase in c-section rates nationwide.

Cesarean sections have been

hitting headlines a lot lately. We’ve been hearing about the rising c-section

rate, now above

30% and rising, for months, and in early June we learned that women

have been denied

health insurance coverage because of previous cesareans. A few days later,

the March of

Dimes reported that 92% of preterm births were delivered by c-section.

When the media covers the

rising rate of c-section, it’s often ready to lay the blame at the feet of a

woman we’re come to know well over the last few years — the busy career mom

scheduling her delivery between important business deals, penciling in labor

and delivery the way she pencils in a client meeting. As criticism of surgical

birth mounts, the idea that mother-initiated c-sections are spurring an overall

increase in the practice has only become more popular.

In mid-April

(coincidentally also Cesarean Awareness

Month) , Time Magazine claimed that Choosy

Mothers Choose Cesareans. Euna Chung, a child psychiatrist in Los Angeles, told Alice Park that she planned her c-section before she was even pregnant. Park wrote of Chung,

"a combination of having watched traumatic vaginal

deliveries in medical school and hearing about her mother’s difficult emergency

caesarean experience after trying to deliver vaginally helped make up her

mind." Chung told Time, "I had a fear of going through labor and ending up with

an emergency C-section anyway. I know that’s rare, but I didn’t want to deal

with it." A recent Today show

segment picked up on this supposed phenomenon, referring to the trend as

"babies on demand." Dr. Judith Reichman, the expert obstetrician on the show

reported National Institutes of Health Statistics that approximately 2% of all

c-sections nationwide can be considered "cesarean deliveries on maternal

request."

While the media likes to use these

stories of maternal demand as attention-grabbing hooks for their reporting on

the rise in c-section rates, other birth advocates and birthing rights

organizations take issue with the "mother’s choice" frame. Our Bodies Ourselves’

recently released book "Pregnancy and Birth" explains that the studies which

produce data like what Dr. Reichman referenced is flawed and not at all

conclusive:

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Although some

studies describe an increase in caesareans without any medical indication, the

authors of these studies are clear that these may not represent real ‘maternal

request.’ The studies, based on birth certificates or hospital billing records,

have no way of documenting whether the caesarean was initially sought by the

mother, whether it was based on physician advice or pressure, or whether there

was simply poor record keeping.

These

advocates argue that while there invariably are some women who are choosing casareans without medical reasons, they do not represent a significant enough

percentage to account for huge increase in c-sections in the last decade. In

other words, some moms may be requesting surgical birth, but that has little to

do with the overall increase in c-section rates. Childbirth Connection’s most

recent survey Listening

to Mothers survey reports that just one woman in 1600 actually reported

having a first c-section because she chose and planned it ahead of time without

any medical reason – a rate far lower than the 2% suggested by Dr. Reichman on

the Today Show.

Does it do any harm when the media,

doctors and others point to mother’s choice as the reason behind higher c-section

rates? These advocates argue that it takes away attention from the how decisions

related to pregnancy and childbirth are really made: often, under intense

pressure from the woman’s physician.

Childbirth Connection explains, "There is a change in practice standards

that reflects an increasing willingness on the part of professionals to follow

the cesarean path under all conditions. In fact, one quarter of the Listening

to Mothers survey participants who had cesareans reported that they had

experienced pressure from a health professional to have a cesarean." Even if

women are reporting a choice for cesarean, Childbirth Connection and others

argue that women aren’t making decisions about their mode of delivery in a

vacuum; rather, they are deeply impacted by the opinions and guidance of their

providers. Lamaze

International explains, "What women hear from obstetricians

powerfully influences what they think. Some obstetricians think so little of

the risks, pain, and recovery of cesarean surgery that they feel that ‘convenience,’

‘certainty of delivering practitioner,’ and ‘[labor] pain’ justify performing

this major operation on healthy women."

When physicians talk up convenience and don’t give air time to possible

complications resulting from c-section, it’s no wonder women make decisions in

the same terms.

What makes these advocates the

angriest, though, is the implication that doctors who support a woman’s right

to elect a c-section do so because they believe in supporting all of women’s

choices around how they want to give birth. Quite the opposite, says Lamaze

International: