The upmarket London borough is well above the national average for the childbirth procedure

The hospital serving the London borough of Chelsea, the smartest and most fashionable in the capital, has the highest caesarean rate in England, inviting the irresistible conclusion that its female residents are "too posh to push".

More than one third of births to women at the Chelsea and Westminster hospital, located a stone's throw from the modish King's Road, is by caesarean, figures show.

It is the fourth year in a row that the flagship, 400-bed hospital has topped the league table for caesareans. Its rate of 36.4 per cent was more than twice the 15.3 per cent rate at Shrewsbury and Telford NHS Trust, and well above the national average of 24.8 per cent, one in four of all births.

A spokesperson for the hospital complained that its private unit had been included in the figures, which gave a distorted impression.

"We have done a lot of work to get our caesarean rate down. Our figures show that for NHS births our rate is below 25 per cent . We are trying to get to the bottom of this," a spokesperson for the trust said.

The NHS Information Centre which published the figures, dismissed the criticisms. It said they related to NHS-funded births only. These would include births in the private unit only if they were paid for by the NHS.

"The trust has been consistently high for the last four years. We stand by our report," a spokesperson said.

The second-highest caesarean rate in the country of 34.2 per cent is at the hospital serving one of the poorest London boroughs, Newham in the east end, a world away from Chelsea in the west.

But while almost half of caesareans at Chelsea and Westminster are planned in advance (925 out of 2023) only a quarter are planned at Newham Hospital NHS Trust (478 out of 1761). The remainder are emergency caesareans suggesting more women present late in their pregnancies with problems at Newham.

Seven out of 10 NHS trusts with the highest caesarean rates are in London. There is a north-south divide with the capital having the highest rate (28.2 per cent) and the North East the lowest (22.4 per cent).

Cathy Smith, head of midwifery at the Shrewsbury and Telford Hospital NHS Trust, with the lowest rate, said: "We try and have a department-wide ethic of natural childbirth and employ all the techniques in maternity care that are recognised by national bodies for reducing the caesarean section rates."

Louise Silverton, deputy general secretary of the Royal College of Midwives, said the high caesarean rate in London may be linked to a shortage of midwives.

"There are more midwifery vacancies in London," she said. "We know one-to-one care from a midwife increases the possibility of a normal delivery."

Caesareans have more than doubled in the past 20 years to their present level of one in four births in England. For years the World Health Organisation had a target of a 15 per cent caesarean rate but that has now been dropped.

In the UK the National Institute for Clinical Excellence issued new guidelines this month giving women the right to have a caesarean, even where it is medically unnecessary, if all attempts to dissuade them failed.