Leading Article: A woman has the right to choose, naturally

THERE ARE two reasons why the rate of births by Caesarean section is increasing in this country towards American levels. One is the pressure from the medical profession, as medicine becomes an increasingly high- technology business and doctors become increasingly defensive about the threat of litigation. But the other is pressure from mothers themselves, who are also becoming more risk-averse and responding defensively to the growing literature of popularised medicine - not to mention the tiny minority who opt for the "convenience" of avoiding the supposed trauma of natural birth on the date of their choice.

The balance between the two factors is a matter of argument: the doctors say they are under pressure from assertive mothers; the natural birth lobby say they are under pressure from high-handed doctors worrying about their liability insurance. The most telling statistic in all this is the fact that 30 per cent of women obstetricians say they would opt for a Caesarean for themselves, while 95 per cent of midwives say they would choose a natural birth. This reflects the fact that doctors tend to see the cases with complications, whereas the overwhelming majority of the cases seen by midwives are relatively straightforward.

In this difficult area there are only two things which can be said with any certainty. One is that a woman's right to choose should be the lodestar. The medical profession is still too rigid in its assumptions about normal procedure for childbirth, and it is too inflexible about women's individual preferences.

The other is that women must have the information on which to base their choice, but in this they should tend to rely on the perception of midwives that childbirth is a natural event, rather than that of doctors that it is a risk-laden crisis. With the proportion of Caesarean births now nearly one in five, we have probably passed the point where the risks of the operation exceed those of childbirth itself.

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