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Too posh to push? C-sections rise with social status

Are wealthy women too posh to push? A new British study shows that upper-class women are more likely to get elective C-sections, raising new questions about who get the surgery -- and why.

C-sections are the most frequently performed major surgery in the U.S., according to the International Cesarean Awareness Network. Around a third of U.S. pregnancies end with the operation, and in Britain, a quarter of babies make their entrance this way.

These facts don't sit well with the World Health Organization, which says C-sections should happen in no more than 5 percent to 15 percent of all deliveries.

What's going on? Researchers looked at 20 years of information on Scottish babies born via C-sections and the social class of their mothers -- 365,000 women in all. 

The data, published in the British journal BMC Public Health, showed that in the early 1980s, elective C-sections were mostly performed on women from lower socioeconomic classes. By the early 2000s, the findings were reversed: Upper-class women were more likely to have scheduled C-sections.

Some have dubbed this finding “Too Posh to Push,” but others don’t feel that’s the case.
Dr. Shari Lawson, obstetrician with Johns Hopkins Bayview Hospital, says the link between social class and rates of C-sections raises questions that the study doesn’t address. She suggests, “It might be that women who are from more affluent areas might also have more education and they’re asking their doctors more pointed questions that make an elective C-section the right thing for a particular patient.” 
Anyone who has ever recovered from a C-section, or knows a woman who has, clearly understands that major abdominal surgery is not a quick and easy way to opt out of the risks involved in pregnancy and labor.  Other reasons for more elective C-sections may include more women facing complications caused by advanced maternal age, obesity or high blood pressure.

We could certainly use more research to help understand why C-sections are performed and how to use that data to improve the outcomes for mom and baby, but the current report has one glaring omission.

There is no data kept on the reason given for the procedure.  Mom’s age, weight, length of pregnancy and even height were analyzed, but doctors didn’t collect data on the reasons given for having an elective C-section.

Maybe the best way to determine why more women are undergoing elective C-sections is simply to ask.

Tell us: Did you have a C-section, elective or emergency? What do you think of the latest research?

Jamila Bey is a journalist and speaker in Washington DC.