I realize provocative blurbs lead to the holy grail of clicks, but can't we take this issue out of the realm of accusing mothers and doctors of laziness? Talk about unwarranted fears, talk about increased liability risks, talk about the impact of economics on medical care, but stop providing fodder to the argument that expectant mothers and their doctors are simply lazy slobs.

Without a doubt monetary considerations by the hospital and doctors affect medical decisions being made. OB/GYN is one of the most litigious branches of medicine, and a doctor can't help but think not only of the patients interest, but of how they can cover themselves if things go poorly. This system doesn't encourage a doctor to think critically, but rather encourages them to follow one-size-fits-most policies crafted to limit liability.

I'm 23, and have a 2.5 year old son. Most of my friends my age don't have kids, but it often comes up in conversations, and a healthy percentage of them insist that when they are pregnant one day, they're going to schedule C-sections. It's not because they're lazy (at least, that never comes up), it's because they're terrified of the pain of giving birth, and the idea of being knocked out and then waking up and your newborn is there sounds incredibly appealing. I have to admit that I listen to this talk skeptically, because I have a hard time believing that when these women are actually focused on having a child they'll hold this same opinion. I think that when they get pregnant, they'll read up on it, learn all the options, find out how much is involved in being post-op, and make a more educated decision. But maybe that decision will still be to have a C-section.

"I ended up getting sliced open and gutted like the Christmas goose"

What a disgusting analogy. I think it would be hard to be more crass.

Again with the "too posh to push" canard!

The reason for C-sections is risk avoidance -- in the overwhelming majority of cases, to reduce risks to the babies who are being born, sometimes very obvious risks.

Now, there is a legitimate debate about whether there may be better risk-avoidance options than C-sections in certain individual cases. And there is legitimate debate about whether U.S. doctors are overly swayed by liability fears when they are making their own risk assessements.

But take it from someone who's been there, done that and gotten the T-shirt: Having your gut cut open to deliver a baby, or actually, for any reason, is no picnic. It's major, major surgery, it's scary, it's exhausting, it requires a very long convalescence and it has permanent and adverse impacts on the body. I would have preferred an uncomplicated vaginal birth, had that been possible.

I've been through two C-sections, the first a dire death-avoiding emergency, the second a calculated choice made after weighing risks of a VBAC with those of a planned C-section. Based on my experience, my advice is that mothers should avoid C-sections if they can, be happy if they can, but know that C-sections are sometimes the least risky medical options.

But they are NOT easy and they are NOT the lazy way out.

Why are older and more affluent women more likely to get C-sections? Aside from the additional childbirth risks that older women carry, this demographic is more likely to know about more of the risks that may exist for their babies. More extensive health care means more diagnosis. After all, if it weren't for fancy fetal monitors, many women in labor wouldn't get the warning signs about their babies' crashing heartrates.

I should have added, too, that there is legitimate devate about the financial pressures bearing on the decision.

For example, a scheduled C-section is less expensive than an emergency C-section. So, if you're considering a VBAC, there's a risk of things going wrong again and having an emergency C-section anyway, meaning, among other things, additional costs that may be paid for out of pocket if that's the way your health-insurance policy works.

But still, I renew my objection to the concept that C-sections are "lazy." This operation ain't no face lift, ladies.

Atul Gawande had an interesting article in The New Yorker (9 Oct. 2006) titled "The Score"; it's about "how childbirth went industrial." Basically he sets up a distinction between craft and industry--if medicine is a craft, he writes, then you can expect OBs to become expert in the highly specialized labor-and-delivery skills that are available to help move a difficult pregnancy along (like the use of forceps, for example, or techniques for delivering breech babies, etc). But if medicine is an industry (which it is, of course), then you can't expect all OBs to become good enough at these difficult and highly specialized skills to wield them successfully often enough, so you look instead for the "simpler, more predictable" (his words) solution to delivery problems--the C-section. He argues that from a medical standpoint it's easier to teach someone how to do a C-section (an extremely straightforward operation) than to teach how to use forceps correctly.

I'm not a hospital-birth-basher: both my kids were born in the hospital and I was attended by MDs (no midwives--personally, I like doctors). My experiences were fine by me (took home two healthy kids) though the first one was pretty medicalized (induction, long unproductive labor, epidural, forceps extraction, lots of internal tearing of my vaginal walls, lots of blood loss). But I do recognize that in the U.S. (and elsewhere too, I'm sure), the craft model has long gone the way of the dodo--it's an industry, and just like McDonald's has achieved world domination (joking, sort of) by finding the simplest, most predictable, most easily repeatable and easily replicable way of churning out its product, so has medicine.

The reason for c-sections isn't because women are taking the "easy way out". The motivating factor is risk avoidance for MDs.

My SIL (an ob/gyn) pays over 300,000/YEAR for malpractice insurance and she has never been sued. She needs to keep it that way because if she is sued -- much like your auto insurance after an accident -- she pays even more. And the bad outcome doesn't even have to be her fault. We live in a society where there are so few bad outcomes when it comes to having children so that if a baby comes out anything less than perfect, then it *MUST* have been the doctors fault. It couldn't just be because some times bad things happen during childbirth.

The key statistic in all of this is that affluent women are much more likely to have c-sections. Why? Because affluent families are much more likely to have the means and the "ego" to sue if anything goes wrong. Guess what group of families are the second most likely to sue for malpractice (after lawyers) -- families where either the mother or father is an MD. And don't think the treating physician doesn't know this.

I also really take offense to the notion that C-sections somehow make you "less of a mother/woman" than the "natural childbirth" crowds. Carol Lloyd's description is just plain grotesque and really does a disservice to any woman who has a c-section or may wind up having one.

When we are pregnant -- regardless of how that child comes into the world -- the goal is the same: to have a happy, healthy baby and a happy healthy mom. Ultimately, it doesn't matter *HOW* that goal is reached. As the mother of a 7 year old and a 10 year old, every year on their birthdays, we are honoring their birth and their life. We don't care or even acknowledge that they were brought into this world by c-section. If it doesn't matter *NOW* -- why should it matter at the time of their birth?

To me, this whole "debate" is much like the "working mother" vs "SAHM" debate -- just another way to pit one group of mothers against another.

Proud mom with the c-section scars (and boys) to prove it!