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http://www.boston.com/news/globe/editorial_opinion/oped/articles/2006/04/03/mothers_arent_behind_a_vogue_for_caesareans/"''TOO POSH to push." The headline, which originated in British tabloids, has been used to capture what is claimed as a trend toward an increasing number of medically elective caesareans requested by upper-class mothers. A just concluded National Institutes of Health meeting on the topic of ''Maternal Request Caesareans," both by the mere title of the conference and its draft report, suggests such a trend exists and that it contributes to a record caesarean rate in the United States.
The problem is that there is no systematic evidence of such a trend. Although some studies do describe an increase in caesareans without any medical indication, this phenomenon may not represent real ''maternal request" at all. These 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 whether there was simply poor record keeping.
Moreover, there has been only one representative national study, entitled ''Listening to Mothers," that directly surveyed mothers about their birth experience, including those who had a caesarean section. It found that far less than 1 percent of mothers who had a first caesarean had requested it. Thus, although there are undoubtedly some women who do seek elective caesareans, they are hardly enough to increase the number of caesareans by 400,000 nationally since 1996. An NIH meeting that uses the title ''Caesarean Delivery on Maternal Request" may unfortunately only reinforce a public perception that women are now seeking caesareans in large numbers, without good evidence that this is the case.
The emphasis on maternal request is easy to understand. With caesarean rates at an all-time high -- accounting for 1.2 million surgeries (29% of all births) in 2004 -- there is naturally interest in seeking new explanations, and ''patient choice caesareans" makes for great media coverage. Such stories often include human interest elements, involve broader ethical issues, and briefly summarize a major social change. Notably, mothers with the highest caesarean rates in the United States -- African-American women over 35 -- are rarely featured in such coverage.
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