Too posh to push; too busy to push; too scared to push. Three clichés used to explain the increase in the number of pregnant women asking to have their babies delivered by Caesarean section. I have little professional experience of women who believe labour is beneath them, or those whose diaries are so full that they can’t leave the onset of labour to nature. I do, however, have plenty of experience of women who are frightened by the prospect of childbirth, but is an elective Caesarean the easier option it is often perceived to be?

The term Caesarean is thought to be derived from the Latin caedere, meaning “to cut”, and the Roman law Lex Caesarea, which stated that if a pregnant woman died, her baby should be removed from her womb and buried separately. Contrary to popular belief, it is not derived from Julius Caesar, who was probably born naturally since his mother lived into her forties – a remarkable feat for anyone who had their abdomen cut open prior to antisepsis and anaesthesia. Indeed, Lex Caesarea is thought to pre-date Caesar by at least 500 years, so he is probably named after the operation, rather than the other way round.

Two millennia later and one in four babies in the UK is now delivered by Caesarean section according to the latest NHS statistics – double what it was 20 years ago.

Emergency Caesarean sections, carried out for problems such as foetal distress, a prolapsed umbilical cord or failure to progress in labour, still account for the lion’s share, with both midwifery and medical staff increasingly likely to err on the side of caution if either mother or baby seem to be getting into trouble.

The vast majority of the remaining planned (elective) sections are done for good medical reasons, such as the baby lying in an awkward position, multiple pregnancy (twins, triplets, etc) and an abnormally positioned placenta.

Once again, it is only natural for the healthcare professionals to take the safest option, and in these days of increasing litigation, doing something is generally perceived as being better than doing nothing.

But there is also a small but growing number of women who are opting for an elective Caesarean even though there is no medical need to do so. Caesarean on demand is not technically possible on the NHS, but can often be negotiated if the mother is assertive enough — which may explain why babies born under the Chelsea and Westminster NHS Trust are twice as likely to be delivered by section as those born in more deprived areas.

It is also much easier to get what you want in the private sector. One baby in three born at London’s leading private maternity unit, the Portland Hospital, is now delivered by elective Caesarean.

So, all things being equal, what are the pros and cons of opting for a section instead of a vaginal delivery — assuming that both mother and baby are well and the pregnancy is progressing smoothly?

The benefits to mother include less damage to her pelvic floor, which will reduce the incidence of incontinence and prolapse later in life. But that doesn’t mean they are immune from trouble — recent research suggests that pregnancy, and not just vaginal delivery, is a major risk factor for weakening of the pelvic floor, with women who have had a Caesarean still being one and a half times more likely to develop incontinence than someone who has never had a baby.

The benefits for baby are harder to measure, but the perfect Caesarean under local anaesthesia (typically an epidural) is probably the least traumatic and safest mode of delivery. But, like any medical intervention, it may not go according to plan.

In the late Eighties, women undergoing elective section were eight times as likely to die as women having a vaginal delivery. By the mid-Nineties, thanks to medical advances, the odds had dropped to three times as likely to die, and today the chances of a maternal death are much the same as for vaginal delivery (around one death for every 30,000 deliveries according to the Birth Trauma Association).

But there are other complications that need to be taken into consideration, including blood clots, infection (rates can be as high as 10 per cent), bleeding and discomfort. And then there are the implications for future pregnancies — having a scar on your womb increases the risk of placental abnormalities and rupture of the womb.

The main risk to baby after a section is respiratory distress syndrome (breathing difficulties) but these generally respond well to treatment. There have also been concerns about the impact on bonding and breast-feeding, but any detrimental effect of a Caesarean tends to be short-lived and of little significance in the longer term.

In summary, from a medical perspective, there isn’t a lot to choose between a well-supervised natural delivery and a carefully planned elective section. But there are resource issues for the hard-pressed NHS, and I struggle with the concept of agreeing to requests for a Caesarean based on criteria such as convenience.

Fears about childbirth are a different matter. At the very least they should be explored, as in many cases they can be allayed by proper explanation of the processes involved and the help that is available (such as pain relief). But if the woman is still frightened then I would regard this as a valid indication for considering an elective section.

But then, as a male doctor, I have a slightly warped perception of pregnancy and childbirth. Although you may be interested to know that in a recent survey of female obstetricians, three out of ten said they would opt for an elective Caesarean if given the choice. Mind you, that means seven out of ten wouldn’t.

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Pauline McDonagh-Hull, a writer, is 35 and lives in Surrey. She has two children, Charlotte, 2, and Jack, five months, who were both delivered by elective Caesarean

“I researched my options thoroughly before having my first baby and always thought that an elective Caesarean was the safer and preferable option. No birth is risk free, but the research seemed to show that, as long as you get to 39 weeks, the risk of foetal and respiratory distress are lower with a Caesarean. I always knew I wanted a small family — no more than two children.

“There was also the realisation that even if I didn’t have an elective Caesarean, in this country I had a 15 per cent chance of having an emergency Caesarean and I just felt better planning it, knowing that I was mentally prepared. Other people had warned me that I might not bond well with my baby and that I risked not having skin on skin contact immediately afterwards. But, unlike many of my friends who had vaginal deliveries, I looked forward to the day and had what can only be described as a wonderful experience.

“I had the same doctor all the way through, was out of bed the following day and up and about when I got home. I never got sore and didn’t take any heavy-duty painkillers after having my second baby. All I needed was ibuprofen.

“Although I got a slight wound infection with my first child, it was nothing serious and no worse than anything my friends who had a normal delivery had. Both my children and I bonded immediately and I was able to breast-feed — another misnomer dispelled.

“I feel that women are given the choice to control other aspects of their reproductive system with the Pill and fertility treatment, so why not childbirth? I would do it again, 100 times over, if I was thinking of having another baby.”

Suzanne Borrell, 37, is an events manager from Brighton. She has two children, George, 4, who was delivered by Caesarean, and Ruby, 1, who was a natural delivery

“With my first baby I wanted an entirely natural birth but I was in labour at home for 20 hours and was taken into hospital because the midwife said there was not enough progression. Neither the baby nor I were in great danger, although for the first eight hours I had no pain relief and was tired. At the hospital we persisted with trying to have a natural birth for a while, but was then persuaded it would be better to have a Caesarean.

“I was devastated and really didn’t want to go down that route, but was talked into it for safety reasons. During the operation I felt terribly passive and not part of it at all. I was not even told I had given birth to a baby boy until the midwives mentioned they were washing ‘him’. There was no celebration as such — it was all part of a procedure.

“I really felt cheated of the normal birth process and, yes, I felt a failure. I was weepy and low after the birth and continued to be very depressed for several months afterwards. From the time my son was born I struggled with feelings that I was not a good mother. I was very sore after the operation and it took weeks for me to get over that, too.

“At baby groups I felt isolated and my depression grew worse — most people were discussing the labour, the transition and who cut the cord and I felt totally left out. I am certain that my depression was entirely down to the Caesarean — I was euphoric after the birth of my daughter, who had a natural vaginal delivery three years later.

“I really think women are designed to give birth naturally and that our bodies are hormonally prepared to deal with that, not with an operation and the white-coat syndrome of a Caesarean.”

Peta Bee