New guidelines will allow Caesareans only where there are medical reasons. Christen Pears looks at how the cost of the 'too posh to push' brigade is affecting a woman's right to choose.

VICTORIA Beckham, Madonna and Zoe Ball are among the growing number of women said to be 'too posh to push' - mothers-to-be who opt for an elective Caesarean so they can fit the birth of their baby round their hectic work commitments. But it isn't just celebrities who are having Caesareans.

The number of Caesarean births in the UK has risen steadily over the last few years to 21.3 per cent - a five-fold increase since 1970. Of the 29,000 babies born in the North-East last year, one in five was delivered by Caesarean section. Nationally, the figure is one in four, well above the ten per cent rate recommended by the World Health Organisation.

A report published last month by the Royal College of Midwives said that many of the operations are "unwanted, unnecessary, and a financial drain on the NHS" and called for new guidelines to be introduced.

Earlier this week the National Institute of Clinical Excellence (NICE), said it was considering tightening up the rules over when pregnant women can have a Caesarean. It suggested that "maternal request" is not a good enough reason for a woman to have the operation, effectively ruling out elective procedures made for lifestyle rather than medical reasons and placing Caesareans on a similar footing to some forms of plastic surgery.

The vast majority of women who have Caesareans on the NHS do so because their doctors feel there is a medical reason for the procedure. The Countess of Wessex's daughter was delivered by Caesarean section at the weekend when she was rushed to hospital with severe stomach pain.

Babies born by Caesarean are more likely to need specialist neo-natal care. Complications for the mother can include haemorrhaging, scarring and damage to the fallopian tubes or ovaries, and NICE's guidance suggests women should be discouraged from having the operation when there is no good medical reason.

Dr Helen Simpson, a consultant obstetrician at James Cook University Hospital in Middlesbrough, says she has noticed an increase over the last ten years and puts it down to changes in medical practice. Caesareans are now far more common for breach births, while women who have their first baby by Caesarean are more likely to opt for surgery the second time round. However, elective C-sections are still relatively rare in the North-East.

Dr Simpson says: "I think if you went to a London hospital, you would find it happening more frequently but here, only two out of the 40 elective Caesareans were for other reasons than medical."

She says most obstetricians want to avoid performing Caesareans if possible but, in some clinical situations, it is the only option.

"If you have been labouring for hours and hours and there is no way the baby is going to be delivered or it is compromised in some way, we would suggest a Caesarean. We have to work out what's best for the patient's safety and the baby's safety. We look at each individual situation and decide what the best management plan is."

Maggie Lyle, from Lanchester, gave birth to her first son, Joe, naturally but her second son, Michael, was born by Caesarean section four years later.

She says: "I won't pretend that giving birth to Joe was easy. It was actually quite a long, hard labour, but I had absolutely no regrets. I had an epidural to cope with the pain and Joe was born naturally.

"I had my second son by Caesarean because, between the two, I had quite a bad car crash and did a lot of damage to my pelvis. It wasn't impossible for me to have a natural birth but the doctors thought it would be better if I had a Caesarean. There was less risk of any complications.

"Having been through it, I can't understand why anyone would have an elective Caesarean unless it's an emergency or there's a good medical reason. I found the whole process quite awful. People forget this is major surgery. It took me a long time to recover and I even had to be careful when I picked Michael up because I was in a lot of pain.

"In a way, I felt cheated because I wasn't really involved. You go into theatre and at the end of it, you're presented with a baby. It's not the same as giving birth naturally."

In order to ensure that women understand the implications of choosing a Caesarean section over normal birth, the Royal College of Midwives believes that women must be given unbiased information on the benefits and risks of normal birth versus Caesarean - a view backed by NICE.

NICE's recommendations are contained in a first draft of the guidance, which is out for consultation. The final guidance will not come into effect until April 2004.