For millennia, cesarean sections were performed for only one purpose - to deliver a baby just before or just after its mother died. Only 500 years ago was the first reported case of a woman who survived the ripping open of her abdomen and uterus and sewing them closed. But today, a growing number of healthy women around the world request a cesarean rather than a vaginal delivery because they fear the pain or want to be "in control." And many physicians go along to avoid lawsuits.
Cesareans can be a lifesaver for women and their babies if labor does not proceed, the fetus remains in a feet-down or horizontal position or is suffering from distress. But cesarean delivery on maternal request (CDMR) has become a medical, ethical, financial and legal dilemma in both the developed and developing worlds.
THE WORLD Health Organization has recommended that the cesarean rate be no higher than 15% of all deliveries. While the rates are very low - under 5% - in countries like Haiti, Nigeria, Uganda, Eritrea and Uzbekistan, 20-30% is today considered "moderate" in the United Kingdom, Canada, Ireland, Germany, Switzerland, Cuba and Portugal. One-fifth of deliveries in Israel and nearly one-third in the US are cesareans, while high rates are found in Italy (36%), Mexico (39%), China (40%) and Brazil (where it is an astonishing 80%).
As the rates among countries vary so wildly, it is clear that there are cultural, psychological, legal, medical, technological and other reasons for why some societies have many CDMRs and others have few…