No one is more familiar with these distressing repercussions than the doctors who treat them. Last August, Dr. Kathleen Kobashi, a Seattle urological surgeon, told the Seattle Times that she chose a C-section because she didn't want to risk the pelvic floor problems that she fixes in other women. UCLA urologist Jennifer Berman wrote a detailed account on her Web site about why she chose a C-section with her second child. After delivering her first child, Max, she completed a reconstructive surgery fellowship and saw women who suffered from incontinence and prolapse -- where the uterus can fall through the vaginal opening -- as a result of vaginal delivery. "Had I seen patients with such problems before Max was born, I would have elected to have a C-section with him, too," she writes.

Just because a woman delivers vaginally does not mean she will experience long-term problems. But a new study of 363 women from Tel Aviv University does show that elective C-section can have a protective effect. The prevalence of urinary incontinence one year after women delivered vaginally was 10.3 percent, but for women who had an elective C-section with no labor, it was only 3.4 percent. (It was 12 percent for women who had a C-section after laboring). Dr. Alison Weidner, an OB/GYN at Duke University Medical Center who sees women on a day-to-day basis suffering from childbirth-related pelvic problems, decided she didn't want to take that risk when her doctor predicted her unborn child would weigh more than 10 pounds. "Twenty percent of women who attempt a vaginal delivery risk ending up with a C-section anyway and a C-section after labor is more risky than doing it before," she says. "The most common cause of complications following C-section is infection, including infection of the uterus and wound infections, which is highly associated with prolonged labor and prolonged rupture of membranes. By definition, if the section is performed electively, these two situations of prolonged labor and rupture of the amniotic membranes don't exist, substantially decreasing the likelihood of infection after delivery." Weidner also points to the fact that it's estimated that overall morbidity is reduced from 24 percent to less than 5 percent when C-section is performed electively, as opposed to in labor. "This is a very touchy topic," she admits. "But in my mind, it should be an individualized decision between a patient and a doctor. When you need treatment for, say, prostate cancer, you have options. I don't understand why delivery of an infant is any different."

Scheduling birth is a not a uniquely American phenomenon. In Brazil, the overall cesarean delivery rate is 50 to 60 percent and climbs to 90 percent among wealthy women delivering in private hospitals. South Korea has one of the highest C-section rates in the world, with almost half of Korean women delivering by C-section (up from 6 percent in 1985 and 21.3 percent in 1995). In Denmark, nearly 40 percent of OB/GYNs agree with the woman's right to request a C-section. But recent media coverage of Hollywood's elective C-section trend with headlines like "Too Posh To Push" (Time) have given the issue a sense of elitism. For example, actress Denise Richards told People magazine in April that she scheduled her delivery around the television taping schedule of her husband, actor Charlie Sheen. Critics are concerned that all of the hype blurs the reality of what women having surgery have to go through. "It's like any fad out there," says Meg Ferrante, a natural-childbirth instructor near Atlanta. "It sounds great and easy and fast and painless and some women enter into it excited, like it's a day at the spa."

As word spreads and more women jump on the C-section bandwagon, healthcare specialists worry about the consequences. On average, C-sections are twice as expensive as vaginal deliveries. Can maternity wards handle a rising demand for elective C-sections? Yes, says Bost, since those numbers don't apply to elective C-sections. His research, published in the Journal of Obstetrics and Gynecology, found that when you factor in nursing, medication, and monitoring during long labor, the costs of vaginal deliveries and elective C-sections balance out. He concluded, "Adopting a policy of cesarean on demand should have little impact on the overall cost of patient care."

Feeney, who is scheduled to become a mom this month, is hoping her personal choice will help pave the way for other women. "I am thrilled at the thought of planning the birth of my baby, of knowing when he'll come and being totally ready," she says. "I embrace the medical technology that will turn what could be 20 or 30 hours of excruciating and unpredictable pain into a 30-minute procedure that will birth my baby for me, with some predictable discomfort during recovery. I would not have it any other way."

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